Medical Coding Auditor

United States

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  • 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara)

Who we are:

We Are Modernizing Medicine (WAMM)! We’re a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany.

 

ModMed is hiring a driven Medical Coding Auditor to join our positive, passionate, and high-performing BOOST Services team focused on delivering top-tier coding compliance and accuracy for our clients. This is an exciting opportunity to play a key role in upholding coding quality standards and supporting audit and denial management processes within a fast-paced Healthcare IT company that is truly Modernizing Medicine!

The Medical Coding Auditor conducts coding reviews and quality assurance audits to verify that all applicable guidelines associated with ICD-10-CM, HCPCS, CPT procedural coding, and modifier usage are followed by the BOOST coding team and the global coding teams. The Medical Coding Auditor also performs as a denial management coder, which reviews and analyzes coding denials and provides needed corrections of these claims when applicable, and performs quality assurance on global denial coding teams' processes.  

Medical Coding Auditors must maintain continuous contact with the BOOST internal and global coding teams to provide statistical and qualitative feedback on the coding quality and aid in education and guidance consistent with established coding and compliance guidelines. They will perform duties under the supervision of the Medical Coding and Auditing Manager. 

Your 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 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 inquires, 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 inquires 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)

Skills & 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

#LI-REMOTE #LI-SM2

ModMed Benefits Highlight:  At ModMed, we believe it’s important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:

India

  • Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
  • Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,
  • Allowances: Annual wellness allowance to support your well-being and productivity,
  • Earned, casual, and sick leaves to maintain a healthy work-life balance,
  • Bereavement leave for difficult times and extended medical leave options,
  • Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,
  • Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.

United States

  • Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution,
  • 401(k):  ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.
  • Generous Paid Time Off and Paid Parental Leave programs,
  • Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs,
  • Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed,
  • Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning,
  • Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles,
  • Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.

PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (first.lastname@modmed.com). Please check senders’ email addresses carefully.  Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.

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