SIU Medical & Behavioral Health Coding Auditor

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

Job summary

CVS Health is seeking a Certified Professional Coder to join our Special Investigations Unit (SIU). The CPC will perform medical claim reviews across medical, behavioral health, transportation and related services to ensure coding accuracy.

You will produce detailed summaries, discuss findings with investigators and leaders, apply CMS guidelines, and help detect errors, abuse and potential fraud while maintaining thorough records and meeting performance metrics.

Qualifications

• AAPC CPC certification and 3+ years of coding experience.
• Experience with CPT, HCPCS, Revenue Codes and CMS 1500/UB04.
• Strong ability to interpret and apply coding policies and guidelines.
• Proficiency with Excel and Word.
• Willingness to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of findings.
• Articulate findings to investigators, leadership, regulators, and providers.
• Research state or CMS guidelines related to reviews with minimal support.
• Identify potential billing errors, abuse, and fraud; suggest savings opportunities.
• Maintain thorough records and meet performance metrics.

Skills

CPC certification

Medical record review

Documentation auditing

CPT, HCPCS, Revenue Codes

CMS guidelines

MS Excel

MS Word

Travel willingness

Education

AAPC CPC certification

GED or high school diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder to join our Special Investigations Unit (SIU). The CPC will perform medical claim reviews across medical, behavioral health, transportation and related services to ensure coding accuracy.

You will produce detailed summaries, discuss findings with investigators and leaders, apply CMS guidelines, and help detect errors, abuse and potential fraud while maintaining thorough records and meeting performance metrics.