Job Overview We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVSHealth®, 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. Responsibilities Determine correct coding and appropriate documentation during the review of medical records. Ensure that 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 a 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 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 and documentation and use department resources regularly. Follow workflows with minimal assistance or intervention to perform daily work and meet metrics. Maintain up-to-date coding knowledge, including new changes to coding compliance and reimbursement. Required Qualifications AAPC Certified Professional Coder certification (CPC). 3+ years of experience in medical coding or documentation auditing. Knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD‑10, CMS1500 and UB‑04 data elements. Experience with researching coding and policies. Experience with Microsoft products, specifically Excel and Word. Preferred Qualifications CPMA certification. Strong attention to detail and ability to review and interpret data. Excellent communication and analytical skills. Prior payor auditing experience. Two years or more previous experience with Behavioral Health coding/auditing of records. Education GED or equivalent. AAPC CPC certification required. Salary & Benefits The typical pay range for this role is: $43,888.00 – $93,574.00. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. The position is eligible for a CVSHealth bonus, commission or short‑term incentive program in addition to the base pay range. Eligible for a comprehensive benefits package including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources. Application Information Application window closes on: 08/22/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr