SIU Medical & Behavioral Health Coder & Auditor

Istss; Annapolis (MD); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to support the Special Investigations Unit. The role focuses on comprehensive medical record reviews to ensure proper CPT/HCPCS/Revenue code coding and documentation, with detailed findings communicated to investigators and regulators.

You will review cases with Medical Directors, apply state and CMS guidelines, and identify potential billing errors or fraud while maintaining meticulous records and meeting performance metrics.

Qualifications

• Certified Professional Coder (CPC) certification required.
• Minimum of 3 years of medical and/or behavioral health coding experience, with 1–2 years in medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Proficiency with Microsoft Excel and Word.
• Willingness to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators and leaders across departments and to regulators.
• Research state or CMS guidelines and apply them to reviews.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud; suggest savings opportunities.
• Maintain organized records and adhere to workflows to meet metrics.
• Stay up-to-date with coding changes and reimbursement rules.

Skills

CPC certification

Medical coding

CPT/HCPCS knowledge

Revenue Codes

CMS 1500/UB04 data elements

Microsoft Excel

Microsoft Word

Communication skills

Ability to travel

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to support the Special Investigations Unit. The role focuses on comprehensive medical record reviews to ensure proper CPT/HCPCS/Revenue code coding and documentation, with detailed findings communicated to investigators and regulators.

You will review cases with Medical Directors, apply state and CMS guidelines, and identify potential billing errors or fraud while maintaining meticulous records and meeting performance metrics.