SIU Medical & Behavioral Health Coder & Audit Specialist

Voices for Voices; Jackson, Northern (MS, KY); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Retirement savings options

Job summary

CVS Health seeks a Certified Professional Coder for the Special Investigations Unit to review medical records for coding compliance and documentation accuracy across healthcare providers. The role demands knowledge of CPT/HCPCS and CMS guidelines, with emphasis on accurate coding and regulatory alignment.

The CPC must articulate findings to investigators and leadership while identifying billing errors and fraud indicators, maintaining up-to-date coding knowledge and meeting performance metrics.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of medical/behavioral health coding experience.
• 1-2 years of current professional coding experience including medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Experience with Microsoft Excel and Word.
• Ability to travel for the role.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research and apply state or CMS guidelines to reviews.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding-related investigative research and policy review.
• Identify potential billing errors, abuse, or fraud.
• Identify savings opportunities warranting prepayment review.
• Maintain records and follow workflows to meet metrics.

Skills

CPC certification

Medical coding experience

Record review

Auditing

Microsoft Excel

Travel willingness

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health seeks a Certified Professional Coder for the Special Investigations Unit to review medical records for coding compliance and documentation accuracy across healthcare providers. The role demands knowledge of CPT/HCPCS and CMS guidelines, with emphasis on accurate coding and regulatory alignment.

The CPC must articulate findings to investigators and leadership while identifying billing errors and fraud indicators, maintaining up-to-date coding knowledge and meeting performance metrics.