SIU Medical & Behavioral Health Coder & Auditor

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy, documentation integrity and compliance across medical and behavioral health records.

Required CPC certification, 3+ years of professional coding experience, familiarity with CPT/HCPCS/Revenue codes, CMS 1500/UB04 data elements, and proficiency with Excel/Word. Travel may be required. Full-time with comprehensive benefits.

Qualifications

• AAPC CPC certification.
• Minimum of 3 years of medical/behavioral health coding experience, with 1-2 years in record review and auditing.
• Knowledge of CPT, HCPCS and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Experience with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, law enforcement, counsel and regulators.
• Research CMS guidelines related to the review with minimal support.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative coding research for state and federal policies.
• Identify potential billing errors, abuse and fraud.
• Identify savings opportunities for prepayment reviews.
• Maintain appropriate records and documentation.
• Follow workflows to meet daily metrics with minimal intervention.
• Maintain up-to-date coding knowledge and reimbursement changes.

Skills

CPC certification

Medical coding experience

Documentation auditing

CMS guidelines knowledge

Excel / Word proficiency

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy, documentation integrity and compliance across medical and behavioral health records.

Required CPC certification, 3+ years of professional coding experience, familiarity with CPT/HCPCS/Revenue codes, CMS 1500/UB04 data elements, and proficiency with Excel/Word. Travel may be required. Full-time with comprehensive benefits.