SIU Medical & Behavioral Health Coding Specialist

Voices for Voices; Frankfort (KY); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Benefits package

Bonus eligibility

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform meticulous medical record reviews, ensure coding accuracy with CPT/HCPCS/Revenue Codes, and verify documentation across medical, behavioral health, transportation, and other services.

The role requires 3+ years of coding experience, CPC certification, proficiency with CMS 1500/UB04 data elements, and the ability to communicate findings to investigators and leadership.

Qualifications

• AAPC CPC certification.
• Minimum 3 years of medical/behavioral health coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500/UB04 data elements.
• Proficient in Excel and Word; ability to travel.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research and apply CMS/state guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding-related investigations and policy review.
• Identify billing errors, abuse, fraud, and savings opportunities.
• Maintain records and follow workflows to meet metrics.
• Keep up-to-date coding knowledge and reimbursement changes.

Skills

CPC certification

Coding knowledge CPT/HCPCS

Auditing experience

MS Excel/Word

Travel flexibility

Education

GED or High School diploma

AAPC CPC Certification

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform meticulous medical record reviews, ensure coding accuracy with CPT/HCPCS/Revenue Codes, and verify documentation across medical, behavioral health, transportation, and other services.

The role requires 3+ years of coding experience, CPC certification, proficiency with CMS 1500/UB04 data elements, and the ability to communicate findings to investigators and leadership.