SIU Medical & Behavioral Health Coding Auditor

Istss; Austin (TX); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services.

The role requires 3+ years of professional coding, CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and the ability to travel if needed. Strong communication and auditing skills are essential for collaboration with investigators and regulators.

Qualifications

• AAPC CPC certification is required.
• Minimum 3 years of medical/behavioral health coding experience, including record review and auditing.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500/UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research state or CMS guidelines related to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with investigative coding research and policy reviews.
• Identify billing errors, abuse, and fraud patterns.
• Identify savings opportunities for potential prepayment reviews.
• Maintain documentation and records.
• Follow workflows to meet performance metrics.

Skills

CPC certification

Medical coding

CPT/HCPCS knowledge

CMS 1500/UB04

Excel/Word

Travel ability

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 SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services.

The role requires 3+ years of professional coding, CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and the ability to travel if needed. Strong communication and auditing skills are essential for collaboration with investigators and regulators.