SIU Medical & Behavioral Health Coding Auditor

Istss; City of Albany (NY); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus potential

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews ensuring coding accuracy and documentation compliance. The role requires 3+ years of coding experience, CPT/HCPCS knowledge, and the ability to communicate findings to investigators and regulators.

Travel may be required. Anticipated weekly hours are 40 with a full-time schedule and eligibility for comprehensive benefits and bonuses.

Qualifications

• Requires AAPC CPC certification and 3+ years of medical/behavioral health coding experience.
• Ability to interpret and apply coding policies and guidelines.
• Experience with CPT, HCPCS, Revenue Codes, CMS 1500 and UB04.

Responsibilities

• Conduct comprehensive medical record reviews to verify coding and documentation alignment.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research state and CMS guidelines related to reviews with minimal support.
• Collaborate with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud; suggest prepayment review opportunities.
• Maintain records and follow workflows to meet performance metrics.

Skills

Attention to detail

Written communication

Auditing / documentation review

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews ensuring coding accuracy and documentation compliance. The role requires 3+ years of coding experience, CPT/HCPCS knowledge, and the ability to communicate findings to investigators and regulators.

Travel may be required. Anticipated weekly hours are 40 with a full-time schedule and eligibility for comprehensive benefits and bonuses.