Medical Coding Auditor
ModMed
full-time
Posted on:
Location Type: Remote
Location: Florida • United States
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Job Level
About the role
- Responsible for analyzing, reviewing and providing feedback when performing quality assurance activities and completing QA audits, including but not limited to: Ensuring all federal and state coding guidelines and regulations are met as well as payer guidelines
- Provide effective feedback to the global coding teams to aid in their successful coding of BOOST clients
- Maintaining a communication log to show successful training of the global coding team when coding trends or issues are found
- Report all coding trends and issues to the department lead as they are identified
- Review target cases per month based on the ModMed Quality Assurance SOP
- Accurately document their daily audit results in the Daily Audit Log and communicate coding resolutions to the BOOST or global coding teams
- Collaborate with the global coding teams on inquiries, clarifications, QA rebuttals and training requests
- Work alongside coding leadership in regards to global coding teams training of coding processes as well as attending remote coding sessions with the global coding teams
- Help with other daily communications between the internal BOOST RCM teams and the Auditing team in regards to other coding inquiries or issues
- Perform BOOST special Quality Assurance audits on the global coding teams
- Perform BOOST or Compliance audits when requested by BOOST or other ModMed staff which help to determine coding compliance or client documentation issues
- Support in the review, appeal and follow-up of third-party (RAC, CERT, etc.) audits
- Assist in review and maintenance of coding guidelines, coding scrub edits and/or practice coding instructions and assist with continuous quality improvement by helping with the process of implementation and carry through of coding protocols and procedures
- Collaborate with fellow coding/auditing team members to maintain department compliance and effectiveness
- Responsible for obtaining continuing education units (CEU) for maintaining coding certification(s)
Requirements
- Minimum 1-year experience as a Certified Professional Coder required - physician-based and/or ASC-based - multi-specialty coding experience preferred
- Minimum 1-year experience as a Certified Professional Medical Auditor (CPMA), preferred not required
- Must agree to obtain CPMA auditing certification within 6 months of employment (if not a CPMA already)
- Knowledge of CPT, ICD-10 CM, HCPCS, CPT coding, modifiers, E/M and all 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 LCD’s, NCDs and other payer coverage policies, required
- Understanding of EOBs and ERA’s, denial remarks and claims review, preferred
- Detailed knowledge of medical billing, preferred
- Detailed knowledge of medical coding systems, procedures and documentation requirements, required
- Ability to interpret and apply coding guidelines for federal, state, and local standards, required
- Proficient with Microsoft programs (Excel, Word) as well as use of overall computer functions, preferred
- Experience in gMed/gGastro or EMA/PM is preferred but not required
- Highly detail-oriented with a critical degree of accuracy regarding data entry
- Exceptional written, verbal and interpersonal communication skills
- Ability to clearly isolate and define trends/problems and provide alternatives or solutions
- Strong analytical skills such as the ability to identify, research, and resolve issues
- Excellent time management skills with an emphasis on managing changing work priorities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
CPT codingICD-10 CMHCPCScoding guidelinesmedical coding systemsmedical billingcoding compliance regulationsNCCI bundling editsLCDsNCDs
Soft Skills
detail-orientedanalytical skillstime managementinterpersonal communicationwritten communicationverbal communicationproblem-solvingfeedback provisioncollaborationtraining
Certifications
Certified Professional CoderCertified Professional Medical AuditorCPMA auditing certification