SIU Medical Coding & Fraud Audit Analyst (CPC)

Istss; Madison (WI); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews and ensure coding accuracy across CPT, HCPCS, and revenue codes. The role involves detailed record reviews, communicating findings to investigators and leadership, and applying CMS/state guidelines.

The ideal candidate will have AAPC CPC certification, 3+ years in medical coding with auditing experience, proficiency in Microsoft Excel/Word, and willingness to travel as

Qualifications

• AAPC CPC certification required.
• Minimum of 3 years of medical/behavioral health coding experience with 1–2 years current professional coding experience including medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements.
• Ability to interpret, apply, and consistently apply coding policies and guidelines.
• Experience with Microsoft Excel and Word; willingness to travel.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes reflect documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research and apply CMS/state guidelines related to reviews.

Skills

Detail oriented

Verbal communication

Written communication

Willingness 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) for the Special Investigations Unit to perform medical claim reviews and ensure coding accuracy across CPT, HCPCS, and revenue codes. The role involves detailed record reviews, communicating findings to investigators and leadership, and applying CMS/state guidelines.

The ideal candidate will have AAPC CPC certification, 3+ years in medical coding with auditing experience, proficiency in Microsoft Excel/Word, and willingness to travel as