SIU Medical Coding Investigator (CPC)

Pennsylvania Psychological Association; Oklahoma City (OK); 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, ensuring coding accuracy and compliance with state, CMS and company guidelines. You will review CPT/HCPCS/Revenue codes, prepare detailed written findings, and communicate results to investigators, providers and regulators.

Travel may be required. A CPC certification, 3 years of coding experience with medical record review, and proficiency in CPT/HCPCS are required;

Qualifications

• AAPC CPC certification required and active.
• At least 3 years of medical/behavioral health coding experience with review of records.
• Strong knowledge of CPT, HCPCS, Revenue Codes; CMS 1500/UB04.

Responsibilities

• Conduct comprehensive medical record reviews to verify codes match documentation.
• Provide detailed written summaries of findings from reviews.
• Articulate findings to investigators, leadership, and regulators.
• Research CMS/state guidelines with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with investigations related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities for potential prepayment reviews.
• Maintain records and documentation; follow workflows to meet metrics.
• Keep up-to-date coding knowledge with changes in compliance and reimbursement.

Skills

Attention to detail

Written communication

Travel flexibility

Education

AAPC CPC certification

GED or High School diploma

CPMA certification

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 with state, CMS and company guidelines. You will review CPT/HCPCS/Revenue codes, prepare detailed written findings, and communicate results to investigators, providers and regulators.

Travel may be required. A CPC certification, 3 years of coding experience with medical record review, and proficiency in CPT/HCPCS are required;