SIU Medical & Behavioral Health Coder & Audit Specialist

CVS Health Corporation; Phoenix (AZ); On-site; USD 56,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Paid time off

Job summary

CVS Health Corporation is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews ensuring coding accuracy and documentation alignment.

The role requires 3+ years of coding and record review experience, CPC certification, and ability to articulate findings to multiple stakeholders. Travel may be required. The position offers full-time hours and a comprehensive benefits package.

Qualifications

• Must have CPC certification and 3+ years of medical coding experience including medical record review.
• Familiarity with CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements.
• Proven ability to interpret and apply coding policies; strong Microsoft Office skills.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy against documentation.
• Provide detailed written summaries of review findings for SIU investigations.
• Explain findings to investigators, leadership, law enforcement, legal counsel, providers and regulators.
• Apply state or CMS guidelines to coding reviews with minimal support.
• Review cases with Medical Directors to validate decisions and discuss cases.
• Identify potential billing errors, abuse, or fraud and opportunities for prepayment review.

Skills

Analytical thinking

Attention to detail

Communication skills

Travel ability

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews ensuring coding accuracy and documentation alignment.

The role requires 3+ years of coding and record review experience, CPC certification, and ability to articulate findings to multiple stakeholders. Travel may be required. The position offers full-time hours and a comprehensive benefits package.