SIU Medical & Behavioral Health Coder & Fraud Auditor

Pennsylvania Psychological Association; Bismarck (ND); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and proper documentation across medical, behavioral health, and related services. The role requires detailed record analysis and the ability to communicate findings to diverse stakeholders.

The ideal candidate has 3+ years of coding experience, CPT/HCPCS knowledge, and proficiency in Excel/Word.

Qualifications

• Minimum of 3 years of experience in medical and/or behavioral health professional coding, with 1-2 years of current coding experience including medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements.
• Ability to interpret and apply established coding policies and guidelines.
• Proficiency with Microsoft Excel and Word; willingness to travel as 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, regulators, and providers.
• Research and apply state or CMS guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding questions, policy analysis, and potential fraud detection.
• Identify billing errors and opportunities for savings warranting prepayment review.
• Maintain organized records and follow workflows to meet metrics.
• Stay up-to-date on coding compliance and reimbursement changes.

Skills

Medical coding expertise

Record review

Documentation auditing

Attention to detail

Verbal and written communication

Education

AAPC CPC certification

GED or High School diploma

CPMA certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and proper documentation across medical, behavioral health, and related services. The role requires detailed record analysis and the ability to communicate findings to diverse stakeholders.

The ideal candidate has 3+ years of coding experience, CPT/HCPCS knowledge, and proficiency in Excel/Word.