SIU Medical Coding Auditor (CPC) — Behavioral Health

CVS Health Corporation; Trenton (NJ); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role requires thorough coding accuracy, documentation auditing, and the ability to communicate findings to investigators and leadership.

Travel may be required to support reviews and investigations. Qualified candidates will have AAPC CPC certification, at least 3 years of medical/behavioral health coding experience with 1-2 years of current

Qualifications

• AAPC CPC certification is required.
• At least 3 years of medical/behavioral health coding experience, including 1-2 years of current professional coding and medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Experience with CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Experience with Excel and Word.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billed codes align with documentation.
• Provide detailed written summaries of review findings.
• Communicate findings to investigators and leadership.
• Research and apply state or CMS guidelines related to reviews.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and meet performance metrics.
• Stay up-to-date with coding changes and reimbursement.

Skills

CPC certification

Medical coding experience

Medical record review

CPT/HCPCS knowledge

CMS 1500/UB04 data elements

Microsoft Excel

Microsoft Word

Travel flexibility

Education

CPC Certification (AAPC)

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role requires thorough coding accuracy, documentation auditing, and the ability to communicate findings to investigators and leadership.

Travel may be required to support reviews and investigations. Qualified candidates will have AAPC CPC certification, at least 3 years of medical/behavioral health coding experience with 1-2 years of current