SIU Medical Coding Auditor (CPC) – Fraud & Compliance

Istss; Trenton (NJ); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and proper documentation in medical records. The role requires knowledge of CPT/HCPCS, CMS guidelines, and ability to communicate findings to investigators and leadership.

Travel may be required. Ideal candidates hold CPC certification and 3+ years of coding experience, including record review and auditing, with proficiency in Excel/Word and a commitment to accuracy

Qualifications

• Demonstrated ability to interpret, apply, and consistently apply established coding policies and guidelines.
• 3+ years of medical and/or behavioral health coding experience including medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Communicate findings to investigators and leadership as needed.
• Apply state or CMS guidelines to reviews with minimal guidance.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud.
• Maintain thorough records and documentation.

Skills

Communication skills

Microsoft Excel

Microsoft Word

Medical record review

Education

CPC certification

High school diploma or GED

3+ years coding experience

Tools

CPT knowledge

HCPCS knowledge

CMS guidelines familiarity

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and proper documentation in medical records. The role requires knowledge of CPT/HCPCS, CMS guidelines, and ability to communicate findings to investigators and leadership.

Travel may be required. Ideal candidates hold CPC certification and 3+ years of coding experience, including record review and auditing, with proficiency in Excel/Word and a commitment to accuracy