SIU Medical & Behavioral Health Coding Investigator

Preferra Insurance; Lansing (MI); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to ensure coding accuracy across medical, behavioral health, and related services. The role requires reviewing records, articulating findings to investigators and regulators, and applying CMS/state guidelines with precision.

The candidate will identify billing errors and fraud indicators while maintaining thorough documentation and meeting performance metrics.

Qualifications

• Must hold CPC certification and have 3+ years of coding experience, including medical record review.
• Knowledge of CPT/HCPCS and Revenue Codes; familiarity with CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies, and communicate findings clearly to investigators and stakeholders.

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, plan leadership, law enforcement, legal counsel, providers and regulators.
• Research and apply CMS/state guidelines related to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud; suggest savings opportunities.
• Maintain records and meet departmental metrics.

Skills

Attention to detail

Strong written and verbal comms

Ability to travel

Education

AAPC CPC certification

GED or High School diploma

CPMA certification (preferred)

CFE/AHFI accreditation (preferred)

Tools

MS Excel

MS Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to ensure coding accuracy across medical, behavioral health, and related services. The role requires reviewing records, articulating findings to investigators and regulators, and applying CMS/state guidelines with precision.

The candidate will identify billing errors and fraud indicators while maintaining thorough documentation and meeting performance metrics.