SIU Medical Coding & Compliance Analyst (CPC)

Voices for Voices; Columbus (OH); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical Insurance

Dental Coverage

Vision Coverage

Paid Time Off

Retirement Savings

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy and compliant documentation across medical, behavioral health, and related services.

The role requires CPC certification, 3+ years of coding experience including record review, proficiency with CPT/HCPCS and revenue codes, familiarity with CMS 1500/UB04, strong communication, and ability to travel if needed.

Qualifications

• AAPC CPC certification required.
• 3+ years medical/behavioral health coding experience with record review.
• Knowledge CPT, HCPCS, Revenue Codes; CMS 1500/UB04 data elements.
• Able to interpret and apply coding policies consistently.
• Proficient with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record reviews for coding accuracy.
• Provide detailed written summaries of 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; suggest savings.

Skills

Medical coding

Record review

Documentation auditing

CMS guidelines

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy and compliant documentation across medical, behavioral health, and related services.

The role requires CPC certification, 3+ years of coding experience including record review, proficiency with CPT/HCPCS and revenue codes, familiarity with CMS 1500/UB04, strong communication, and ability to travel if needed.