SIU Medical Coding Investigator & Audit Analyst

Preferra Insurance; Hartford, Northern (CT, KY); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The role ensures coding accuracy, proper documentation, and compliance with state and federal requirements.

The candidate should have 3+ years of medical coding experience, CPC certification, and strong communication skills to present findings to diverse stakeholders. Travel may be required.

Qualifications

• AAPC CPC certification required.
• Minimum of 3 years medical/behavioral health coding experience with 1–2 years in medical record review.
• Knowledge of CPT, HCPCS and Revenue Codes; CMS 1500 and UB04 data elements.
• Proficient in Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS codes.
• Provide detailed written summaries of findings.
• Articulate findings to investigators, leadership, and regulators.
• Research CMS guidelines related to reviews.
• Identify billing errors, abuse, or fraud.
• Maintain records and adhere to workflows to meet metrics.
• Stay updated on coding changes.

Skills

CPC Certification

Medical coding

Documentation auditing

Attention to detail

Travel willingness

Education

GED or High School diploma

Tools

CMS 1500

UB04 data elements

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The role ensures coding accuracy, proper documentation, and compliance with state and federal requirements.

The candidate should have 3+ years of medical coding experience, CPC certification, and strong communication skills to present findings to diverse stakeholders. Travel may be required.