SIU Medical & Behavioral Health Coding Auditor

Voices for Voices; Lansing (MI); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus or incentive program

Medical, dental and vision coverage

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 SIU, ensuring coding compliance across medical, behavioral health, and related services. The role demands precise documentation, ability to articulate findings to multiple stakeholders, and adherence to state, federal, and company guidelines.

The position requires CPC certification and 3+ years of coding/record review experience, with strong knowledge of CPT/HCPCS and CMS data elements.

Qualifications

• AAPC CPC certification required.
• Minimum of 3 years of medical/behavioral health coding experience with 1–2 years current professional coding and record review.
• Knowledge of CPT, HCPCS, Revenue Codes and CMS 1500/UB04 data elements.
• Proficiency with Microsoft Excel and Word.
• Ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators, leadership, providers, regulators, and counsel as needed.
• Apply state or CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding questions, state and federal policies investigations.
• Identify potential billing errors, abuse and fraud.
• Identify savings opportunities for prepayment reviews.
• Maintain records and follow workflows to meet metrics.

Skills

CPC certification

Medical coding experience

Record review

MS Excel

MS Word

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 compliance across medical, behavioral health, and related services. The role demands precise documentation, ability to articulate findings to multiple stakeholders, and adherence to state, federal, and company guidelines.

The position requires CPC certification and 3+ years of coding/record review experience, with strong knowledge of CPT/HCPCS and CMS data elements.