SIU Medical & Behavioral Health Coding Specialist

Voices for Voices; Charleston (WV); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to join the Special Investigations Unit in the United States. You will perform medical claim reviews to ensure coding and documentation align with CPT/HCPCS rules and payer guidelines.

You will prepare detailed written findings, communicate with investigators and regulators, and support fraud identification and cost savings opportunities while maintaining compliance with state, federal, and company standards.

Qualifications

• AAPC CPC certification and 3+ years of medical coding experience, including record review and auditing.
• Knowledge of CPT, HCPCS, Revenue Codes and CMS 1500/UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Proficiency with Excel and Word; ability to handle travel if required.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of review findings.
• Explain findings to investigators, leadership, and regulators.
• Research and apply state or CMS guidelines with minimal support.
• Identify potential billing errors, abuse and fraud; propose savings opportunities.

Skills

CPC coding

Medical record review

CPT/HCPCS knowledge

CMS 1500 & UB04

MS Excel / Word

Travel readiness

Communication skills

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Office

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to join the Special Investigations Unit in the United States. You will perform medical claim reviews to ensure coding and documentation align with CPT/HCPCS rules and payer guidelines.

You will prepare detailed written findings, communicate with investigators and regulators, and support fraud identification and cost savings opportunities while maintaining compliance with state, federal, and company standards.