SIU Medical Coding Auditor & Fraud Investigator

Preferra Insurance; Des Moines (IA); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus program

Comprehensive 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. The role requires CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and the ability to communicate findings to investigators and regulators.

40-hour, full-time position with potential travel. Competitive benefits, eligibility for CVS Health incentive programs, and career growth opportunities in a supportive health-focused environment.

Qualifications

• Must hold AAPC CPC certification and have 3+ years of medical/behavioral health coding experience with record review.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines consistently.
• Proficiency with Microsoft Excel and Word; ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify coding against documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research and apply CMS/state guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud; contribute to savings opportunities.
• Maintain records and follow workflows to meet performance metrics.

Skills

Verbal communication

Written communication

Attention to detail

Ability to travel

Education

AAPC CPC certification

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 SIU, ensuring coding accuracy and compliant documentation. The role requires CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and the ability to communicate findings to investigators and regulators.

40-hour, full-time position with potential travel. Competitive benefits, eligibility for CVS Health incentive programs, and career growth opportunities in a supportive health-focused environment.