SIU Medical Coding Auditor & Investigator

Pennsylvania Psychological Association; Charleston (WV); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to review medical records for coding accuracy and compliance. The role requires independent analysis, detailed reporting, and collaboration with investigators and regulators.

The ideal candidate has 3+ years of medical coding experience, CPT/HCPCS knowledge, and proficiency with Excel/Word. Travel may be necessary, and the position offers full-time hours with a robust benefits package.

Qualifications

• 3+ years of medical and/or behavioral health coding experience, including medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Proficiency with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of findings to investigators and leadership.
• Articulate findings to investigators, plan leadership, law enforcement, and regulators.
• Research CMS/state guidelines and apply them to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding-related investigative research and identify potential fraud or abuse.
• Identify savings opportunities that may require prepayment review.
• Maintain organized records and follow established workflows.

Skills

Attention to detail

Written communication

Verbal communication

Analytical thinking

Education

GED or High School diploma

AAPC CPC certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to review medical records for coding accuracy and compliance. The role requires independent analysis, detailed reporting, and collaboration with investigators and regulators.

The ideal candidate has 3+ years of medical coding experience, CPT/HCPCS knowledge, and proficiency with Excel/Word. Travel may be necessary, and the position offers full-time hours with a robust benefits package.