Medical Coding Auditor

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 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)

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 is 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

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:

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.