SIU Medical & Behavioral Health Coding Specialist

Preferra Insurance

Topeka (KS)

Hybrid

USD 44,000 - 94,000

Full time

9 days ago

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Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. This full-time role involves coding reviews, detailed reporting, and collaboration with investigators and regulators to ensure compliant coding practices.

The position requires CPC certification, 3+ years of coding experience (including record review), and travel as needed. A comprehensive benefits package is provided, with anticipated 40-hour weeks and a base pay

Qualifications

AAPC CPC certification required.
Minimum 3 years of medical or behavioral health coding experience, with 1–2 years in medical record review.
Knowledge of CPT, HCPCS and Revenue Codes.
Familiarity with CMS 1500 and UB04 data elements.
Proficiency in Microsoft Excel and Word.
Willingness to travel if needed.

Responsibilities

Conduct comprehensive medical record reviews to verify coding with documentation.
Provide detailed written summaries of review findings.
Articulate findings to investigators, leadership, and regulators as needed.
Research CMS guidelines and apply coding policies consistently.
Review cases with Medical Directors to validate decisions.
Identify billing errors, abuse and fraud patterns.
Maintain accurate records and documentation required by the unit.
Follow workflows to meet performance metrics.