Certified Professional Coder, Special Investigations Unit (Aetna SIU)

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 ourselvesaccountable 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.

  • Maintains 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, CMS 1500 and UB04 data elements

  • Experience with researching coding and policies.

  • Experience with Microsoft products, specifically 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

  • AAPC Certified Professional Coder Certification (CPC)

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/03/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Back to blog

Other Jobs To Apply

Amazon Delivery Driver

REMOTE - Entry-Level Management Training (Work from Home)No Experience Needed Full Training Provided

Delta Airlines (Data Entry) Work From Home Position Jobs - Apply Now

Film & TV Development & Production Internships: LA - Summer 2026

`Remote Entry-Level Role | Beginner Friendly | Full/Part-Time | Start ASAP

Work From Home Remote Entry Level -Focus Group Position

Fulfillment Center Warehouse Associate

Robotics Warehouse Associate

amazon warehouse associate $15+/ Hour (Sign on Bonus)!

Amazon Warehouse

Sr. Operations Manager

Delivery Driver(06993) - 2753 W Washington

"Fully Remote Benefits Representative | Flexible Schedule | Hiring Immediately

Fulfillment Workplace Health and Safety Specialist Intern 2026 - AZ, CA, CO, NM, NV, OH, OK, TX, UT, WA - Now Hiring

Software Development Engineer III (ADBL189)

Want to Work From Home? Provide Customer Service Support for Leading Cruise Lines - Flexible Hours

DJZ5 - $23.75hr - New Jersey - Amazon DSP Delivery Driver

EHS Specialist

Sales Associate- Redding

Team Member

Remote Travel Specialist (part time)

Remote Data Entry -Time Focus Group Participants (Up To $750/Week)

Data Entry Clerk Work From Home - Part-Time Focus Group Participants (Up To $750/Week)

Remote Healthcare Customer Service Representative

-Urgent Hiring | Entry-Level Remote Role | Flexible Schedule | Apply Today

REMOTE - Entry-Level Management Training (Work from Home)No Experience Needed Full Training Provided

Easy Remote Academic Transcription Jobs No Experience

Immediate Hiring: Virtual Scheduling Assistant-Entry Level

Remote Live Chat Assistant – Entry-Level Customer Support Specialist (No Experience Required | $35/Hour)

Flight Monitor, Amazon - Prime Air

Amazon Prime Delivery Driver $18-$26/hr

Sr. Operations Manager

EHS Specialist

Warehouse Team Member

Warehouse Associate - $18.00/hour

Work From Home - Up to $750/ week

(Part Time) Data Entry - Remote Jobs

Part-Time Doorstep Trash Collection Specialist - Weekends

Front Desk Concierge (Part-Time / Weekend)

EHS Specialist

Area Manager, Early Career (2027) - AR, MS, OK, LA

Warehouse Worker - Central NJ-OCS (collapsed into 763300000)

Amazon Customer Service Representative (Remote)

Remote Customer Service Specialist

Heavy Equipment Operator

Certified Nursing Assistant (CNA) Jobs in Tucson, AZ — $19–$21/hr, Flexible Shifts

Remote Travel Booking Agent (Flexible Schedule)

Pathways Operations Manager Intern - Summer 2027 - Now Hiring

Supervisory Transportation Security Officer

Paid Panel Immediate Start - Remote Part-Time - Customer Service Representative Welcome