SIU Medical & Behavioral Health Coding Investigator

CVS Health Corporation; Tallahassee (FL); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to join the Special Investigations Unit. The role focuses on medical claim reviews to ensure CPT/HCPCS and revenue codes align with documentation and that state, federal, and company requirements are met.

You will articulate findings to investigators and leadership, identify billing errors or potential fraud, and maintain records. The position requires 3+ years of coding experience, CPC certification, familiarity with CMS

Qualifications

• AAPC CPC certification required.
• 3+ years of medical/behavioral health coding experience with 1-2 years in current coding and record review.
• Knowledge of CPT, HCPCS, Revenue Codes; CMS 1500/UB04 data elements.
• Ability to interpret and apply coding policies and guidelines consistently.
• Proficiency with Microsoft Excel and Word; ability to travel.

Responsibilities

• Perform comprehensive medical record reviews for CPT/HCPCS codes and modifiers.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state and CMS guidelines to reviews with minimal support.
• Identify billing errors, abuse, and fraud; maintain case records.
• Collaborate with Medical Directors to validate decisions.

Skills

Medical coding

Record review

Documentation auditing

Communication skills

Attention to detail

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to join the Special Investigations Unit. The role focuses on medical claim reviews to ensure CPT/HCPCS and revenue codes align with documentation and that state, federal, and company requirements are met.

You will articulate findings to investigators and leadership, identify billing errors or potential fraud, and maintain records. The position requires 3+ years of coding experience, CPC certification, familiarity with CMS