SIU Medical & Behavioral Health Coding Auditor

Istss; Augusta (ME); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits package

Eligible for CVS Health bonus program

Paid time off

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for its Special Investigations Unit. The role involves reviewing medical records to ensure CPT/HCPCS coding aligns with documentation, and to identify potential billing errors or fraud.

You will present findings to investigators and plan leadership, while ensuring compliance with state and federal guidelines. Required CPC certification with 3+ years of coding and record review experience.

Qualifications

• Must hold AAPC CPC certification and have 3+ years of coding experience, including medical record reviews.
• Experience with CPT, HCPCS, and Revenue Codes and familiarity with CMS 1500/UB04.
• Ability to interpret and apply coding policies and guidelines consistently.
• Proficient in Microsoft Excel and Word and able to travel if required.

Responsibilities

• Conduct comprehensive medical record reviews to verify coding accuracy against documentation.
• Provide detailed written findings and articulate them to investigators and leadership.
• Review cases with Medical Directors and support investigative research into coding questions.
• Identify potential billing errors, abuse, and fraud; support prepayment review opportunities.
• Maintain organized records and adhere to established workflows to meet metrics.

Skills

CPC Certification

Medical Coding Experience

CPT/HCPCS Knowledge

CMS 1500/UB04 Familiarity

Data Documentation

Education

AAPC CPC Certification

GED or High School Diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for its Special Investigations Unit. The role involves reviewing medical records to ensure CPT/HCPCS coding aligns with documentation, and to identify potential billing errors or fraud.

You will present findings to investigators and plan leadership, while ensuring compliance with state and federal guidelines. Required CPC certification with 3+ years of coding and record review experience.