Medical Coding Auditor

Modernizing Medicine, Inc.; United States; Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Comprehensive medical, dental, and vision benefits

401(k) matching contribution

Generous Paid Time Off

Job summary

Modernizing Medicine, Inc. is looking for a Medical Coding Auditor to join its BOOST Services team. This role focuses on coding compliance and quality assurance within the healthcare IT domain. You will be responsible for conducting coding reviews, maintaining communication with global coding teams, and providing valuable feedback.

The ideal candidate has a minimum of 1-year experience as a Certified Professional Coder and knowledge of federal and state coding regulations. This position offers comprehensive benefits and flexibility with hybrid working options.

Qualifications

• Minimum 1-year experience as a Certified Professional Coder required.
• Knowledge of federal, state and local coding compliance regulations required.
• Exceptional written, verbal, and interpersonal communication skills.

Responsibilities

• Responsible for analyzing and performing quality assurance activities.
• Provide effective feedback to the global coding teams.
• Collaborate with the coding leadership on training requests.

Skills

CPT coding

ICD-10 CM coding

Medical terminology

Analytical skills

Education

Certified Professional Coder

Certified Professional Medical Auditor

Tools

Microsoft Excel

gMed/gGastro

Job description

ModMed – a leading provider of AI‐enabled, specialty‐specific cloud platforms – is hiring a Medical Coding Auditor to join its BOOST Services team.

Job Summary

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 the 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.

Responsibilities

• 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 the 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 inquiries, 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 inquiries 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).

Qualifications

• 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.
• The ability to interpret and apply coding guidelines for federal, state, and local standards is required.
• Proficient with Microsoft programs (Excel, Word) as well as the 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.

Benefits

• 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 the HQ.