SIU Medical Coding Auditor (CPC) - Risk & Compliance

Istss; Northern (KY); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The role ensures that coding and documentation meet state, federal, and company requirements through thorough record reviews.

The CPC will generate detailed findings, communicate with investigators and regulators, research CMS guidelines, and identify opportunities for savings. Travel may be required; full-time position with comprehensive benefits.

Qualifications

• 3+ years of medical or behavioral health coding experience, including record review and auditing.
• CPT, HCPCS and Revenue Codes knowledge required.
• CMS 1500 and UB04 data elements familiarity.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators and stakeholders.
• Apply state or CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud.
• Maintain accurate records and documentation.

Skills

AAPC CPC certification

Medical coding experience

CPT/HCPCS knowledge

Revenue Codes knowledge

CMS 1500/UB04 data elements

Microsoft Excel

Written and verbal communication

Travel ability

Education

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The role ensures that coding and documentation meet state, federal, and company requirements through thorough record reviews.

The CPC will generate detailed findings, communicate with investigators and regulators, research CMS guidelines, and identify opportunities for savings. Travel may be required; full-time position with comprehensive benefits.