SIU Medical & Behavioral Health Coder (CPC) – Claims Audit

CVS Health Corporation; Augusta (ME); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program eligibility

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU), ensuring coding accuracy and compliance with CPT/HCPCS rules across medical, behavioral health, transportation, and related services.

The role requires 3+ years of coding experience, CPC certification, strong written and verbal communication, and the ability to review records, interpret guidelines, and support investigators.

Qualifications

• AAPC CPC certification and at least 3 years of medical/behavioral health coding experience.
• Experience with CPT, HCPCS, Revenue Codes and CMS data elements.
• Ability to interpret and apply coding policies with accuracy.
• Proficiency with Microsoft Excel and Word; ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews for CPT/HCPCS codes against documentation.
• Provide detailed written summaries of findings and articulate to investigators.
• Apply state and CMS guidelines with minimal support; discuss cases with Medical Directors.
• Identify billing errors, abuse, and potential fraud; maintain records and workflows.
• Keep coding knowledge up-to-date and support audit activities as needed.

Skills

Written communication

Verbal communication

Attention to detail

Education

AAPC CPC Certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU), ensuring coding accuracy and compliance with CPT/HCPCS rules across medical, behavioral health, transportation, and related services.

The role requires 3+ years of coding experience, CPC certification, strong written and verbal communication, and the ability to review records, interpret guidelines, and support investigators.