Certified Coding Auditor Primary Care

Marwood Group; New York (NY); Hybrid; USD 85,000 - 120,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Life

AD&D

Voluntary Life

LTD

Spouse and Dependent Life

401k Retirement plan with a company |?

Job summary

The Marwood Group, a healthcare advisory services firm based in New York City with offices in DC and London, is seeking a Certified Coding Auditor to join our New York office or work remotely. You will perform remote billing and coding audits to ensure coding practices meet government and commercial payer regulations.

The ideal candidate holds CPC/CCS-P with 5+ years in healthcare coding/auditing, understands E/M, CPT, HCPCS, ICD-10, and demonstrates strong knowledge of coding compliance and

Qualifications

• CPC/CCS-P certification and at least 5 years in healthcare coding/auditing including E/M, CPT, HCPCS, ICD-10.
• Ability to evaluate documentation supporting medical necessity and billing codes across diverse settings.
• Experience with payor regulations and identifying billing issues (modifiers, bundling, CCI).
• Knowledge of federal and state coding laws and HIPAA requirements.

Responsibilities

• Perform remote audits to ensure coding practices comply with regulations for government and commercial payers.
• Research state and payer rules to identify risk areas and communicate expectations with the team.
• Identify coding issues related to modifiers, bundling, CCI, and units of service.

Skills

CPC/CCS-P

5+ years healthcare coding/auditing

HIPAA/privacy knowledge

Education

AAPC or AHIMA certification

Tools

UB-04 & CMS 1500 knowledge

EHR/EMR systems

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 a 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 payers.

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 inpatient and outpatient settings.

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. The focus will be in the primary care sector (fee-for-service and risk-based), though experience in specialties such as dermatology, vascular, podiatry, wound care, home health, and personal care is preferred. Behavioral health 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 – 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. We offer paid days off, and paid holidays. Marwood prides itself on providing employees with a good work-life balance. There is no travel expected with this position.

• Medical
• Dental
• Vision
• Life
• AD&D
• Voluntary Life
• LTD
• Spouse and Dependent Life
• 401k Retirement plan with a company match
• Commuter
• FSA/DCFSA

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.