SIU Medical Coding Investigator (CPC) - Audits & Compliance

Istss; Springfield (IL); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit. The role focuses on reviewing medical records to ensure correct CPT/HCPCS/revenue codes and accurate documentation.

You will analyze cases, prepare written summaries, and communicate findings to investigators, leadership, and regulators. AAPC CPC certification and 3+ years of experience are required, with proficiency in Excel and Word. The position is full-time with benefits and some travel.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/revenue codes against documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, law enforcement, counsel, regulators.
• Research CMS guidelines and apply state policies with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding questions and audit-related investigations.
• Identify potential billing errors, abuse and fraud.
• Identify savings opportunities for prepayment reviews.
• Maintain records and documentation.
• Follow workflows to meet performance metrics.
• Maintain up-to-date coding knowledge.

Skills

Written communication

Verbal communication

Attention to detail

Travel readiness

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit. The role focuses on reviewing medical records to ensure correct CPT/HCPCS/revenue codes and accurate documentation.

You will analyze cases, prepare written summaries, and communicate findings to investigators, leadership, and regulators. AAPC CPC certification and 3+ years of experience are required, with proficiency in Excel and Word. The position is full-time with benefits and some travel.