SIU Medical & Behavioral Health Coding Auditor

Voices for Voices; Montgomery (AL); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Career growth opportunities

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to conduct medical claim reviews for the Special Investigations Unit (SIU). The role focuses on ensuring coding accuracy, proper documentation, and adherence to state, federal, and company guidelines.

Travel may be required. The ideal candidate has 3+ years of medical/behavioral health coding experience, CPC certification, and proficiency with CPT/HCPCS, CMS 1500, UB04, Excel, and Word.

Qualifications

• AAPC CPC certification required.
• 3+ years medical/behavioral health coding experience.
• Experience with CPT, HCPCS, and Revenue Codes.
• Familiar with CMS 1500 and UB04 elements.
• Proficient with Excel and Word.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators and leadership teams.
• Research state or CMS guidelines related to the review.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding questions and policy investigations.
• Identify potential billing errors, abuse or fraud.
• Maintain records and documentation.
• Follow workflows to meet metrics.

Skills

CPC certification

Medical coding

CPT/HCPCS knowledge

MS Excel/Word

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 conduct medical claim reviews for the Special Investigations Unit (SIU). The role focuses on ensuring coding accuracy, proper documentation, and adherence to state, federal, and company guidelines.

Travel may be required. The ideal candidate has 3+ years of medical/behavioral health coding experience, CPC certification, and proficiency with CPT/HCPCS, CMS 1500, UB04, Excel, and Word.