Analyst SIU Certified Coder at CVS Health

Hartford, Connecticut, United States -

Full Time

Start Date

Immediate

Expiry Date

04 Jul, 26

Salary

93574.0

Posted On

05 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical coding, Auditing, Compliance, CPT, HCPCS, ICD-10, Behavioral health coding, Data analysis, Communication, Investigative research, Microsoft Excel, Microsoft Word, CMS guidelines, Billing pattern analysis

Industry

Hospitals and Health Care

Description

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) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. • Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation. • Provide detailed written summary of medical record review findings. • Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. • Research and accurately apply state or CMS guidelines related to the audit with minimal support. • Review and discuss cases with Medical Directors to validate decisions. • Assist with investigative research related to coding questions, state and federal policies. • Identify potential billing errors, abuse, and fraud. • Identify opportunities for savings related to potential cases which may warrant a prepayment review. • Maintain appropriate records, files, documentation, etc. • Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics. Required Qualifications • Coding experience within ABA or a Behavioral Health Certification • AAPC Coding certification • 3+ 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. • Experience with Microsoft products; Excel and Word Preferred Qualifications • Strong attention to detail and ability to review and interpret data. • Demonstrates strong communication skills. Prior auditing experience Excellent communication skills Excellent analytical skills Two years or more previous experience with Behavioral Health coding/auditing of records Education Certification in Coding Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $43,888.00 - $93,574.00 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. 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/02/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Responsibilities

The analyst will perform comprehensive medical record audits to ensure coding compliance and identify potential billing errors, abuse, or fraud. They will also articulate findings to various stakeholders, including investigators, legal counsel, and medical directors.