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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in CPT, ICD-10-CM, and HCPCS coding, along with a strong understanding of coding compliance regulations and guidelines. Proficient in conducting quality assurance audits and providing training support to coding teams while maintaining effective communication and documentation.
Highest-signal resume keywords
Certified Professional Coder (CPC)CPT CodingICD-10-CM CodingQuality Assurance AuditsMedical Terminology
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CPT CodingICD-10-CM CodingHCPCS CodingModifier UsageDenial Management CodingCoding Compliance RegulationsMedical Coding SystemsData Entry AccuracyStatistical AnalysisCoding Guidelines
Soft Skills
Exceptional Communication SkillsAnalytical SkillsDetail-OrientedTime ManagementProblem-Solving
Tools & Technologies
Microsoft ExcelMicrosoft WordGMed/gGastroEMA/PM
Certifications & Qualifications
Certified Professional Coder (CPC)Certified Professional Medical Auditor (CPMA)
Industry Keywords
Denial ManagementCoding AuditsEOBsERAsNCCI Bundling EditsLCDsNCDsPayer Coverage PoliciesCoding TrendsCompliance Audits
About the role
Key responsibilities & impact- Conduct coding reviews and quality assurance audits for ICD-10-CM, HCPCS, CPT procedural coding, and modifier usage
- Perform denial management coding by reviewing, analyzing, and correcting coding denials and claims when applicable
- Perform quality assurance on global denial coding team processes
- Maintain ongoing contact with internal and global coding teams to provide statistical and qualitative feedback
- Ensure federal, state, coding, and payer guidelines and regulations are met
- Provide feedback and training support to global coding teams
- Maintain communication logs documenting training related to coding trends and issues
- Report coding trends and issues to department leads
- Review target cases monthly according to the ModMed Quality Assurance SOP
- Document daily audit results and communicate coding resolutions
- Collaborate on inquiries, clarifications, QA rebuttals, and training requests
- Attend remote coding sessions with global coding teams
- Support communications between internal BOOST RCM teams and the Auditing team
- Perform special Quality Assurance, BOOST, and Compliance audits
- Support review, appeal, and follow-up of third-party audits
- Assist with maintaining coding guidelines, scrub edits, practice coding instructions, and coding protocols
- Collaborate with coding and auditing team members to maintain department compliance and effectiveness
- Obtain continuing education units for coding certification maintenance
Requirements
What you’ll need- Minimum 1 year of experience as a Certified Professional Coder required, with physician-based and/or ASC-based multi-specialty coding experience preferred
- Minimum 1 year of experience as a Certified Professional Medical Auditor preferred, not required
- 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, CPT 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 preferred
- Detailed knowledge of medical billing 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 preferred
- Experience with gMed/gGastro or EMA/PM preferred but not required
- Highly detail-oriented with a high degree of accuracy in data entry
- Exceptional written, verbal, and interpersonal communication skills
- Ability to isolate and define trends and problems and provide solutions
- Strong analytical skills for identifying, researching, and resolving issues
- Excellent time management and ability to manage changing work priorities
Benefits
Comp & perks- 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