SIU Medical Coding & Compliance Auditor

Voices for Voices; Concord (NH); On-site; 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) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliance across medical, behavioral health, and related services.

The role requires 3+ years of coding experience (1–2 years current), CPT/HCPCS knowledge, CMS 1500/UB04 data elements, and strong communication skills; travel may be required.

Qualifications

• AAPC CPC certification is required.
• 3+ years of medical/behavioral health coding experience, with at least 1–2 years current professional coding.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Experience with Microsoft Excel and Word.
• Ability to travel for the role.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes and modifiers match documentation.
• Provide detailed written summaries of findings.
• Articulate findings to investigators, leadership, and regulators.
• Research CMS/state guidelines related to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding policy-related investigative research.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings warranting prepayment review.
• Maintain records and documentation; meet metrics.

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 Special Investigations Unit, ensuring coding accuracy and compliance across medical, behavioral health, and related services.

The role requires 3+ years of coding experience (1–2 years current), CPT/HCPCS knowledge, CMS 1500/UB04 data elements, and strong communication skills; travel may be required.