Medical Coding Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct reviews of coding and perform quality assurance audits for ICD-10-CM, HCPCS, CPT procedural coding, and modifier application.

• Manage denial coding by assessing, analyzing, and rectifying coding denials and claims as necessary.

• Execute quality assurance for processes related to the global denial coding team.

• Maintain regular communication with both internal and global coding teams to provide statistical and qualitative feedback.

• Ensure adherence to federal, state, coding, and payer guidelines and regulations.

• Offer feedback and training assistance to global coding teams.

• Keep communication logs that document training concerning coding trends and issues.

• Report coding trends and issues to department leadership.

• Review targeted cases monthly in accordance with the ModMed Quality Assurance SOP.

• Document daily audit outcomes and communicate coding resolutions.

• Collaborate on inquiries, clarifications, QA rebuttals, and training requests.

• Participate in remote coding sessions with global coding teams.

• Facilitate communication between internal BOOST RCM teams and the Auditing team.

• Conduct special Quality Assurance, BOOST, and Compliance audits.

• Assist in the review, appeal, and follow-up of third-party audits.

• Help maintain coding guidelines, scrub edits, practice coding instructions, and coding protocols.

• Work with coding and auditing team members to ensure departmental compliance and effectiveness.

• Acquire continuing education units to maintain coding certification.

⛳️ Requirements

• A minimum of 1 year of experience as a Certified Professional Coder is required, preferably with physician-based and/or ASC-based multi-specialty coding experience.

• At least 1 year of experience as a Certified Professional Medical Auditor is preferred, but not mandatory.

• Must agree to obtain CPMA auditing certification within 6 months of employment if not already a CPMA.

• Required knowledge of CPT, ICD-10-CM, HCPCS coding, modifiers, E/M, and coding guidelines.

• Required knowledge of medical terminology and anatomy.

• Required understanding of federal, state, and local coding compliance regulations and guidelines.

• Required understanding of NCCI and CCI bundling edits.

• Required understanding of LCDs, NCDs, and other payer coverage policies.

• Understanding of EOBs, ERAs, denial remarks, and claims review is preferred.

• Detailed knowledge of medical billing is preferred.

• Required detailed knowledge of medical coding systems, procedures, and documentation requirements.

• Ability to interpret and apply federal, state, and local coding guidelines.

• Proficiency with Microsoft Excel, Microsoft Word, and general computer functions is preferred.

• Experience with gMed/gGastro or EMA/PM is preferred but not mandatory.

• Highly detail-oriented with great accuracy in data entry.

• Exceptional written, verbal, and interpersonal communication skills.

• Ability to identify and define trends and issues while providing solutions.

• Strong analytical skills for identifying, researching, and resolving problems.

• Excellent time management skills and the ability to manage changing work priorities.

🏝️ Benefits

• Comprehensive medical, dental, and vision benefits.

• Company Health Savings Account contribution.

• 401(k) matching contribution of 50% of the employee’s contribution deferred on up to 6% of compensation.

• 100% vesting of matching contributions after one year of employment.

• Generous Paid Time Off.

• Paid Parental Leave programs.

• Company-paid Life and Disability benefits.

• Flexible Spending Account.

• Employee Assistance Programs.

• Company-sponsored Business Resource & Special Interest Groups.

• Professional development opportunities.

• Tuition reimbursement programs.

• Unlimited access to LinkedIn Learning.