CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). This role focuses on ensuring coding compliance through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers.
The analyst will determine correct coding and appropriate documentation, identify concerning billing patterns, and help support investigations related to potential fraud, abuse, and coding errors. The role also involves writing review summaries, applying state and CMS guidelines, and communicating findings to investigators, leadership, legal counsel, providers, and regulators.
This is a full-time position with an anticipated 40-hour workweek.
- AAPC CPC certification
- Minimum 3 years of experience in medical and/or behavioral health professional coding
- 1-2 years of current professional coding experience, including medical record review and documentation auditing
- Knowledge of CPT, HCPCS, and Revenue Codes
- Familiarity with CMS 1500 and UB04 data elements
- Ability to interpret and apply coding policies and guidelines consistently
- Experience with Microsoft Excel and Word
- Ability to travel if needed
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Bonus, commission, or short-term incentive eligibility
- Comprehensive benefits package for eligible colleagues and their families
Location
Mississippi, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$43,888 - $93,574
Remote work allowed
No
Posted
1 month ago