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Analyst, SIU Certified Coder
CVS HealthCertified Professional Coder performing medical claim reviews for CVS Health's Special Investigations Unit. Conducting audits and ensuring compliance with coding practices across various healthcare providers.
Posted 5/22/2026full-timeRemote • Connecticut • 🇺🇸 United StatesMid-LevelSenior💰 $43,888 - $93,574 per yearWebsite
About the role
Key responsibilities & impact- Perform medical claim reviews for the Special Investigations Unit (SIU)
- Conduct a comprehensive medical record audit to ensure compliance with coding practices
- Provide detailed written summary of medical record review findings
- 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
- 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
Requirements
What you’ll need- 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
- Strong attention to detail and ability to review and interpret data
- Demonstrates strong communication skills
Benefits
Comp & perks- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical codingdocumentation auditingcoding complianceCPTHCPCSICD-10CMS 1500UB04billing error identificationinvestigative research
Soft Skills
attention to detailcommunication skills
Certifications
AAPC Coding certification