SIU Medical Claims Coding & Audit Analyst

Preferra Insurance; Lincoln (NE); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Retirement benefits

Paid time off

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. You will summarize findings, discuss cases with Medical Directors, and identify potential billing issues or fraud while maintaining records.

The role requires CPC certification, 3+ years in coding with record review experience, and travel as needed. Strong Excel/Word skills and CMS guidance familiarity are essential.

Qualifications

• AAPC CPC certification required.
• At least 3 years of medical/behavioral health coding experience, incl. 1-2 years current coding, including record reviews.
• Knowledge of CPT, HCPCS, Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• MS Office proficiency (Excel & Word).
• Ability to travel for the role.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes match documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, regulators and providers.
• Research CMS/state guidelines related to reviews.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud.
• Maintain organized records and documentation.

Skills

Medical coding knowledge

Communication skills

Travel flexibility

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. You will summarize findings, discuss cases with Medical Directors, and identify potential billing issues or fraud while maintaining records.

The role requires CPC certification, 3+ years in coding with record review experience, and travel as needed. Strong Excel/Word skills and CMS guidance familiarity are essential.