SIU Medical & Behavioral Health Coding Specialist

Preferra Insurance; Springfield (IL); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews and ensure coding accuracy in CPT/HCPCS/Revenue codes. The role requires auditing documentation and communicating findings to investigators and leadership, with travel as needed.

Ideal candidates hold an AAPC CPC certification with at least 3 years of coding and record-review experience, including CMS guidelines, and proficiency in Excel/Word.

Qualifications

• AAPC CPC certification is required.
• Minimum 3 years of medical and/or behavioral health coding experience, including medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Experience with CMS 1500 and UB04 data elements.
• Proficiency with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators and stakeholders.
• Research and apply state or CMS guidelines to reviews.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud and suggest savings opportunities.

Skills

Medical coding

Record review

Documentation auditing

MS Excel

MS Word

Travel ability

Education

AAPC CPC certification

GED or High School diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews and ensure coding accuracy in CPT/HCPCS/Revenue codes. The role requires auditing documentation and communicating findings to investigators and leadership, with travel as needed.

Ideal candidates hold an AAPC CPC certification with at least 3 years of coding and record-review experience, including CMS guidelines, and proficiency in Excel/Word.