CVS Health
SIU Medical & Behavioral Health Coding Analyst
$44K–$94K
CT - Work from home +33 · Remote/Hybrid · Full-time · Posted Oct 7, 2026
- Location
- CT - Work from home
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Work At Home-New Hampshire - Experience
- Minimum 3 years of medical and/or behavioral health professional coding, including at least 1–2 years of current professional coding experience with medical record review and documentation auditing.
- Education
- AAPC Certified Professional Coder Certification (CPC); GED or High School diploma.
About the job
Reviews healthcare provider claims and medical records for the Special Investigations Unit to assess coding compliance, documentation, and potential billing errors, abuse, or fraud.
What you'll do
- Review medical records to verify billed codes and modifiers against documentation, and write detailed findings.
- Research and apply state and CMS guidelines; discuss cases with Medical Directors and communicate findings to stakeholders.
- Identify potential billing issues and savings opportunities, and maintain review records and documentation.
What they ask for
- AAPC CPC certification.
- At least 3 years of medical and/or behavioral health professional coding experience, including 1–2 years of current professional coding with medical record review and documentation auditing.
- Knowledge of CPT, HCPCS, Revenue Codes, and CMS 1500 and UB04 data elements.
- Experience with Microsoft products, including Excel and Word; ability to travel if needed.
Nice to have
- CPMA certification or CFE/AHFI credential.
- Coding and audit experience in a health plan or payer environment.
Pay
$43,888.00 - $93,574.00 (USD, base salary)
Tools
CPT, HCPCS, Revenue Codes, CMS 1500, UB04, Excel, Word
Model-written summary · the original posting is authoritative