SIU Medical & Behavioral Health Coding Auditor

Pennsylvania Psychological Association; Jackson (MS); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Paid time off

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding practice compliance and accurate documentation across medical, behavioral health, transportation, and other healthcare services. The role requires CPT/HCPCS/Revenue code expertise and strong communication with investigators and regulators.

The position involves comprehensive record reviews, applying CMS guidelines, and collaborating with Medical Directors to validate

Qualifications

• AAPC CPC certification required.
• Minimum of 3 years of medical and/or behavioral health professional coding experience, including medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements; ability to interpret coding policies.

Responsibilities

• Conduct comprehensive medical record reviews to verify codes align with documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators, leadership, and regulators as needed.
• Apply state or CMS guidelines to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions, policies.
• Identify potential billing errors, abuse, or fraud; suggest savings opportunities.

Skills

Attention to detail

Written/verbal communication

Travel flexibility

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding practice compliance and accurate documentation across medical, behavioral health, transportation, and other healthcare services. The role requires CPT/HCPCS/Revenue code expertise and strong communication with investigators and regulators.

The position involves comprehensive record reviews, applying CMS guidelines, and collaborating with Medical Directors to validate