SIU Medical & Behavioral Health Coding Auditor

Istss; Jackson (MS); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus program

Comprehensive benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy across medical, behavioral, transportation, and other services, with attention to state and federal regulations.

You will articulate findings to investigators and leaders, review documentation, apply CMS guidelines, and identify billing errors, fraud, and savings opportunities. Travel may be required.

Qualifications

• Must have CPC certification and current AAPC credential.
• 3+ years of professional coding experience with record reviews.
• Familiar with CPT/HCPCS, Revenue Codes, CMS 1500 and UB04 data.
• Proficient in MS Excel and Word; able to travel if needed.

Responsibilities

• Review medical records to verify CPT/HCPCS codes match documentation.
• Provide written summaries of review findings for SIU and leadership.
• Explain findings to investigators, plan leadership, and regulators.
• Research CMS guidelines; apply policies consistently.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, fraud, and savings opportunities.
• Maintain records and comply with departmental workflows.
• Stay up-to-date on coding changes and reimbursement.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500/UB04 knowledge

Microsoft Excel

Travel ability

Education

AAPC CPC Certification

GED or High School diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy across medical, behavioral, transportation, and other services, with attention to state and federal regulations.

You will articulate findings to investigators and leaders, review documentation, apply CMS guidelines, and identify billing errors, fraud, and savings opportunities. Travel may be required.