Provider Coding Auditor, Educator

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

📋 Description

• Assists in coding from finalized surgical and procedural operative reports that are signed by the provider.

• Evaluates complex medical records that require research and reference verification, ensuring the documentation is adequately supported.

• Collaborates with ModMed to verify that the appropriate plans, modifiers, and diagnoses are attached.

• Conducts audits of provider medical records and charges to ensure compliance with coding and documentation standards in alignment with internal and government regulations.

• Provides ongoing review and education to physicians and ACPs to guarantee that the reported level of care is accurate.

• Partners with practices to analyze the findings from periodic chart reviews.

• Maintains a comprehensive understanding of anatomy, physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs, enabling effective application of ICD-10-CM and CPT coding guidelines to diagnoses and procedures.

• Correlates information that supports clinical documentation, including but not limited to Pathology, Radiology, and/or other Physician Consultations, following review by the Attending Physician, when appropriate.

• Regularly meets with physicians and ACPs to provide ongoing education regarding billable services, medical record documentation, correct utilization of CPT and ICD-10 codes, identification of missed billing opportunities, and rectifying erroneously reported services to reduce errors and revenue loss.

• Interacts with management, revenue managers, and others to provide insights into coding-related issues.

• Addresses coding-related inquiries and resolves any issues from providers, office staff, and billing specialists.

• Collaborates with billing specialists and appeal and edit coders to facilitate prompt resolution of accounts.

• Works jointly with billing specialists to devise strategies aimed at enhancing charge capture and billing/coding processes.

• Keeps abreast of current CPT and ICD-10-CM coding guidelines and updates.

• Communicates changes and updates to key stakeholders, including physicians, ACPs, practice managers, and leadership.

• Reports any potential compliance issues to the Director of RCM.

⛳️ Requirements

• Extensive knowledge of E&M coding for surgical procedures and applicable modifiers.

• Understands and applies the appropriate Center for Medicare Services guidelines to coding.

• Proficient in advanced ICD-10-CM & CPT-4 coding conventions.

• Familiarity with Anatomy & Physiology as well as Medical Terminology.

• Ability to become a ModMed expert to assist providers in utilizing the system for improved documentation and coding practices.

• Strong written and verbal communication skills.

• Comfortable presenting to large groups of providers on coding subjects and addressing questions in real-time.

• Capable of working independently and managing time effectively to complete audits and deliver timely results to each provider, along with a written report that includes suggestions for enhancing documentation and coding accuracy.

• Solid understanding of items on the Inspector General watch list for coding and compliance, as well as various payers' medical necessity criteria to ensure that both providers and the organization are positioned to minimize audit risks.

🏝️ Benefits

• Medical, Dental & Vision insurance – effective on the 1st of the month following the start date.

• Short-term and long-term disability, Voluntary life insurance (for employee, spouse, and child), Critical Illness, and Hospital Indemnity – effective on the 1st of the month after the date of hire.

• Company provided Basic Life/AD&D insurance.

• Paid time off.

• Paid holidays.

• Retirement Savings account.

• Employee discounts on cosmetic services and products.