SIU Medical & Behavioral Health Coding Auditor

Preferra Insurance; Phoenix (AZ); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The role ensures coding accuracy, proper documentation, and compliance with state, federal, and company guidelines. Travel may be required for collaboration with investigators and regulators.

The ideal candidate holds an AAPC CPC certification with 3+ years of medical/behavioral health coding and auditing experience, plus proficiency in CPT, HCPCS, andRevenue Codes.

Qualifications

• Certified coder with CPC credential and knowledge of CPT/HCPCS and Revenue Codes.
• Experience reviewing medical records and auditing documentation.
• Familiarity with CMS 1500 and UB04 data elements.
• Ability to interpret coding policies and apply guidelines consistently.
• Proficient in Excel and Word for documentation and analysis.

Responsibilities

• Perform comprehensive medical record reviews to verify codes and modifiers.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state or CMS guidelines accurately during reviews.
• Discuss cases with Medical Directors to validate coding decisions.
• Assist with investigative research related to coding questions.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities warranting prepayment review.
• Maintain records and documentation; follow workflows to meet metrics.
• Stay updated on coding changes and reimbursement policies.

Skills

AAPC CPC certification

Medical coding

Medical record review

Documentation auditing

Travel ability

CMS guidelines

Microsoft Excel

Microsoft 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 perform medical claim reviews for the Special Investigations Unit. The role ensures coding accuracy, proper documentation, and compliance with state, federal, and company guidelines. Travel may be required for collaboration with investigators and regulators.

The ideal candidate holds an AAPC CPC certification with 3+ years of medical/behavioral health coding and auditing experience, plus proficiency in CPT, HCPCS, andRevenue Codes.