Medical Coding Auditor

UNM Medical Group, Inc.; Albuquerque (NM); Remote; USD 54,000 - 69,000; Full time

Job summary

An established industry player is seeking a Medical Coding Auditor to join their Compliance Team. This remote, full-time position offers a competitive salary and a $2,000 sign-on bonus. The role involves auditing medical records for compliance, training staff on coding practices, and ensuring accurate billing. Join a team that values service, integrity, and respect while promoting diversity and inclusion. This opportunity not only offers professional growth but also comprehensive benefits, including medical, dental, and tuition reimbursement. If you're passionate about compliance and coding, this is the perfect opportunity for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Tuition Reimbursement

Paid Time Off

403b Retirement Plan

Qualifications

• 5 years of experience in medical coding and auditing.
• Certification in medical coding is required.

Responsibilities

• Audit medical records for compliance with coding regulations.
• Train staff on documentation and coding practices.
• Collaborate with compliance and coding staff.

Skills

Medical Coding

Auditing

Compliance Knowledge

Documentation Standards

Communication Skills

Education

High School Diploma or GED

Certified Professional Medical Auditor (CPMA)

Relevant Certifications (CPC, CCS, etc.)

Job description

UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a REMOTE, full-time, day shift opening located in Albuquerque, New Mexico.

*This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico*

*$2,000 Sign-on Bonus*

Minimum $54,537 - Midpoint $68,172*

*Salary is determined based on years of total relevant experience.

*Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.

Summary:

Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to review evaluation and management codes, medical diagnoses, and clinical procedures, ensuring accurate medical billing that conforms with legal and regulatory requirements. Trains, instructs, and provides technical support to medical providers, support staff, and medical coding personnel on documentation standards that support billing and coding compliance. Collaborates with hospital compliance and coding staff to ensure consistent provider training on professional and facility services. Reviews, develops, and modifies procedures, systems, and protocols to align with UNM Medical Group billing and compliance standards. Assists management with annual work plan development, risk assessment, and evaluates external payer record requests for reconsideration, appeals, and rebuttals.

Minimum Job Requirements of a Medical Coding Auditor:

High School diploma or GED with 5 years of directly related experience; at least one of the following certifications: CPC, CCS, CCS-P, COC, RHIA, RHIT, or CHONC. Certification or eligibility for Certified Professional Medical Auditor (CPMA). A completed degree from an accredited institution that exceeds the minimum education requirement may substitute for experience on a year-for-year basis. Verification of education and licensure will be required if selected for hire.

The UNM Medical Group (UNMMG) Coding Auditor position requires the candidate to hold a Certified Professional Medical Auditor (CPMA) designation at hire or obtain it within 18 months. UNMMG covers costs for study materials and one exam through the Compliance Department budget.

Duties and Responsibilities:

1. Audits medical record documentation to identify undercoded and overcoded services, prepares reports, and meets with providers and staff to educate on accurate documentation and coding practices in compliance with regulations. Conducts follow-up audits as needed.
2. Reviews billing processes to ensure accurate reimbursement and compliance, including unbundling and other questionable practices.
3. Researches and responds to inquiries regarding compliance, coding issues, denials, and billable services.
4. Interacts with physicians, support staff, and coding personnel on billing and documentation policies, clarifying ambiguous or conflicting documentation.
5. Trains and instructs providers and staff on documentation, regulations, and payer requirements.
6. Develops and modifies procedures, protocols, and data management systems to meet billing requirements for professional and facility services.
7. Assists in formulating the annual work plan and audit protocols to address risks.
8. Reviews external payer requests, including those from third-party payers, Medicare Advantage, and RAC reviews, for reconsideration and appeals.
9. Collaborates with compliance and coding staff to ensure consistent provider education.
10. Maintains strict confidentiality of medical and financial records.
11. Attends conferences and training sessions to stay updated on coding and regulatory changes.

Why Join UNM Medical Group, Inc.?

Since 2007, our organization has grown and formed strong partnerships within UNM Health. We aim to embody values of Service, Positivity, Integrity, Respect, and Excellence in all we do.

Diversity, Equity, and Inclusion:

We promote diversity and well-being across New Mexico through cultural humility and respect for all.

Benefits:

• Competitive Salary & Benefits: Includes medical, dental, vision, and life insurance.
• Additional Perks: Tuition reimbursement, paid time off, and a 403b retirement plan.