Special Investigation Unit (SIU) Manager

CVS Health Corporation; Lansing (MI); On-site; USD 54,000 - 159,000; Full time

Job summary

CVS Health Corporation is seeking a CPC Manager to lead the Special Investigations Unit's medical coding reviews, ensuring CPT/HCPCS accuracy and compliant documentation across multiple provider types.

You will mentor a team of CPCs, conduct audits, resolve complex coding issues, and collaborate with Medical Directors to validate decisions while reporting findings to investigators and plan leadership.

Qualifications

• Must hold AAPC CPC certification.
• 5+ years of experience in medical coding or documentation auditing.
• Strong knowledge of CPT/HCPCS/ICD-10, CMS 1500 and UB04 data elements.
• Maintains up-to-date coding knowledge including changes to compliance and reimbursement.
• Proficiency in Excel and Word; strong attention to detail and data interpretation.
• Excellent communication and leadership abilities; ability to mentor staff.

Responsibilities

• Lead and mentor CPCs, providing training and guidance in coding practices and medical record reviews.
• Conduct regular audits of team performance to ensure CPT/HCPCS coding and documentation standards are met.
• Set team goals, monitor performance, and align with organizational objectives.
• Direct and oversee complex coding reviews and resolve issues for legal, compliance, or rework projects.
• Ensure staff provide detailed written summaries of findings and communicate effectively to investigators, plan leadership, and regulators.
• Conduct staff evaluations and provide ongoing feedback; collaborate with Medical Directors to validate decisions.
• Manage workload distribution to expose team to diverse cases and support development.
• Assist with investigative research related to coding questions, state/federal policies, and identify potential billing errors, abuse or fraud.
• Identify opportunities for savings related to cases warranting prepayment review.
• Maintain records and documentation for the team; ensure workflows meet performance metrics.
• Collaborate with investigators, data analytics, and plan leadership on SIU schemes and initiatives.
• Act as primary contact for the team in the director's absence; develop training/onboarding programs for new members.

Skills

CPC coding expertise

Leadership

Data analysis

Auditing

Education

AAPC CPC certification

Tools

Excel

Word

Job description

Role Overview

The CPC Manager will be responsible for guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on meeting state, federal, and company requirements while identifying concerning billing patterns or trends.

• Lead and mentor a team of CPCs, providing training, guidance, and support in coding practices and medical record reviews.
• Conduct regular audits of team performance to ensure compliance with CPT/HCPCS coding and documentation standards.
• Establish team goals, monitor performance, and ensure alignment with organizational objectives.
• Direct and oversee complex coding reviews and resolve intricate issues with sensitivity, including claim reviews for legal, compliance, or rework projects.
• Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.
• Conducts team member evaluations and provides performance feedback to staff on an ongoing basis.
• Collaborate with Medical Directors to validate decisions and discuss complex cases.
• Manages workload of their team to ensure equitable distribution and exposure to wide range of cases to match current skills and development needs.
• Assist with investigative research related to coding questions, state and federal policies, and identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings related to potential cases that may warrant a prepayment review.
• Maintain appropriate records, files, and documentation for the team.
• Utilize department resources effectively and ensure workflows are followed to meet performance metrics.
• Collaborate with investigators, data analytics, and plan leadership on SIU schemes and initiatives.
• Act as the primary point of contact for the team in the absence of the director, ensuring continuity of operations and support.
• Develop and implement training and onboarding programs for new team members

Requirements

• AAPC Coding certification.
• 5+ years of experience in medical coding or documentation auditing
• Strong knowledge of standard industry coding guides and guidelines, including CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements.
• Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement.
• Experience with researching coding and policies.
• Proficiency in Microsoft products, particularly Excel and Word.
• Strong attention to detail and ability to review and interpret data.
• Demonstrates strong communication and leadership skills.
• Excellent analytical skills and the ability to mentor and develop team members.

Preferred

• 3 + years in a role with direct people management
• 2+ years experience in an SIU team lead role or equivilant
• Prior medical record review within a payer experience is preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 10/17/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.