Certified Coding Auditor - Outpatient

Marwood Group; New York (NY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k plan with company match

Paid days off and holidays

Certification renewal reimbursement

Professional development

Job summary

The Marwood Group is seeking an outpatient Certified Coding Auditor to join our New York office or work remotely. The role involves remote audits to ensure compliant coding practices for government and commercial payors, with a need to interpret HIPAA and payor rules.

Candidates should hold CPC/CCS-P credentials with 5+ years of outpatient coding/auditing experience, strong analytical and communication skills, and familiarity with UB-04 and CMS 1500 data.

Qualifications

• Minimum 5 years of healthcare coding/auditing experience (E/M, CPT, HCPCS, ICD-10).
• Experience with professional billing, coding, and documentation for outpatient providers.
• Ability to evaluate medical necessity and coding accuracy across services.

Responsibilities

• Perform remote billing and coding audits to ensure compliance with regulations and payer policies.
• Research state and payer rules to identify risk areas across settings and specialties.
• Coordinate with team members to communicate expectations and deadlines.
• Articulate audit findings and interpretations of coding regulations to stakeholders.

Skills

CPC/CCS-P

Outpatient coding

Auditing

Attention to detail

HIPAA compliance

Regulatory knowledge

Communication skills

Multitasking

Education

AAPC/AHIMA certification

Tools

EHR/EMR systems

UB-04 / CMS 1500 data

Job description

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firm’s private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, worker’s compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions.

The Advisory Group is currently accepting applications for an outpatient Certified Coding Auditor to work in its New York office or remotely.

Principal duties and responsibilities:

Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payors.

Researching state and payer regulations to identify areas of risk in a variety of healthcare settings and specialties, coordinating with various team members to ensure clear expectations are communicated and deadlines are met.

Qualifications:

CPC/CCS-P with a minimum of 5 years of experience in healthcare coding/auditing (E&M, CPT, HCPCS, and ICD-10), with knowledge of professional billing, coding, and documentation practices performed by physicians and other qualified healthcare providers in the outpatient setting.

Proficiency in evaluating how well clinical documentation supports medical necessity and the E/M, CPT, and HCPCS codes that were billed, across a wide range of services. Experience in specialties such as primary care, dermatology, vascular, podiatry, wound care, home health, and personal care is preferred. Behavioral health and HCC coding experience is also a plus.

Proven ability to identify billing and coding issues including use of modifiers, bundling issues, CCI edits, therapeutic and diagnostic procedures, supplies, materials, injections, drugs, and units of service etc.

Solid understanding of both federal and state coding and documentation laws and regulations, applicable fraud statutes, and regulations, and of federal guidelines on recoupments and other anti-FWA activity. Identify and access risk of repayment or recoupment in the event of payor scrutiny.

Familiarity with both UB-04 and CMS 1500 claims data, as well as understanding of payor remittances.

Knowledge of anatomy, physiology, and medical terminology necessary to appropriately review assignment and documentation of diagnosis codes.

Solid working knowledge of various EHR/EMR systems; experience accessing these remotely.

Strong organizational skills and task management

Highly organized with a high level of attention to detail

Ability to work in a fast paced and rapidly changing environment.

Skilled at multi-tasking with the ability to handle several different priorities simultaneously.

Strong communication skills with experience in articulating audit findings and interpretation of coding regulations

Experience with HIPAA, data privacy, and/or data security processes.

Experience working with regulators governing (public or private) health insurance carriers.

A minimum of AAPC or AHIMA certification required, that could include:

• Certified Professional Coder (CPC)
• Certified Professional Medical Auditor (CPMA)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist – Physician based (CCS-P)

Marwood offers a comprehensive compensation package with full benefits.

We offer a competitive wage, a collaborative work environment and an opportunity to participate in a full benefit package, including, Medical, Dental, Vision, Life, AD&D, Voluntary Life and LTD, Spouse and Dependent Life, 401k Retirement plan with a company match, Commuter, FSA/DCFSA, professional development, and professional certification renewal reimbursement.

• Medical
• Dental
• Vision
• Life
• AD&D
• Voluntary Life and LTD
• Spouse and Dependent Life
• 401k Retirement plan with a company match
• Commuter
• FSA/DCFSA
• professional development
• professional certification renewal reimbursement
• We offer paid days off, and paid holidays.

The position is based in our New York location. Currently working a hybrid schedule. Remote option will be considered.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class.