Medical Coding Auditor

Company: SUMMIT PARTNERS
Location: Boca Raton
Posted on: September 17, 2022

Job Description:

Career - - Medical Coding Auditor ModMed United States of America Applyfor this job

• Job Type: Full-Time
• Function: Accounting/Finance
• Industry: Healthcare IT
• Post Date: 08/17/2022
• Website: modmed.com
• Company Address: 4850 Network Way, Suite 200, Boca Raton, FL, 33431 About ModMedModMed is transforming healthcare by placing doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Job Description At Modernizing Medicine, we look for passionate, innovative, creative Rock Stars!
  • South Florida Business Journal, Best Places to Work 2021
  • Inc. Magazine Best Workplaces of 2020
  • Inc. 5000 Fastest-Growing Private Companies in America - 2015 - 2019
  • Marketing Campaign of the Year for Telehealth - Business Intelligence Group's Public Relations & Marketing Excellence Award 2020
  • Best Use of Technology in Customer Service (Gold) - Customer Sales and Service World Awards - - 2019
  • Customer Service Department of the Year (Gold) - Customer Sales and Service World Awards - 2018
    Modernizing Medicine -delivers truly disruptive and transformative products and services that will impact the healthcare industry. The work we do makes a difference. Our web and mobile applications are transforming healthcare information technology to increase practice efficiency and improve patient outcomes. We offer end-to-end specialty-specific solutions from practice management, through EMR to Revenue Cycle Management (RCM) that help our clients maximize their efficiencies. Modernizing Medicine is hiring a Medical Coding Auditor who is -responsible for ensuring that coding performed on behalf of Modernizing Medicine's RCM clients is in compliance with all published -federal, state and payer specific coding guidelines. -The Coding Auditor maintains continuous contact with both the onshore and offshore RCM teams to provide statistical and qualitative feedback on the quality of coding and provides education and guidance consistent with established coding and compliance guidelines.
    The Role:
    • Research, analyze and respond to inquiries regarding inappropriate coding, denials, rejections or billable services.
    • Ensure accurate coding for diagnosis, procedural coding and modifier usage - dependent on federal, state and payer guidelines.
    • Assist team to accurately resolve coding issues and rejections.
    • Supports in the review, appeal and follow up of third party (RAC, CERT, etc.) audits as needed.
    • Audit new clients, when necessary, to assess potential coding or documentation issues and/or trends.
    • Serve as point of contact and coding compliance SME for coding questions and issues
    • Provides guidance and training to RCM onshore & global teams on proper coding of ICD's, CPT's, HCPCS's and modifier usage as necessary.
    • Responsible for analyzing, reviewing and providing feedback on QA audits performed.
    • Accurately document their daily audit results in the Daily Audit Log and communicate coding resolutions to the RCM or Global Services Team.
    • Perform RCM or Compliance audits when requested by RCM or other ModMed staff which help to determine coding compliance or client documentation issues.
    • Work as an effective denial management coder and assist with resolving reimbursement and denial issues related to coding inaccuracies or insufficiencies.
    • Review medical charts, electronic ERAs, claims, billing notes, etc. and provide detailed notes for denials and task to the appropriate ModMed assignment to be resolved accordingly.
    • Perform RCM or Compliance audits when requested by RCM or other ModMed staff which help to determine coding compliance or client documentation issues.
      Skills & Requirements:
      • Certified Professional Medical Auditor (CPMA) preferred.
      • Certification in one or more of the following: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist-Physician (CCS-P)
      • Minimum 1 year experience as a certified medical coder - physician based and/or ASC based.
      • Minimum 1 year experience as a certified medical auditor (preferred)
      • Minimum of 1 year of multi-specialty coding experience preferred, preferably in GI Surgery coding
      • Must agree to obtain CPMA auditing certification within 6 months of employment (if not a CPMA already) -
      • Must be knowledge in E/M coding - Office/Outpatient and Inpatient and Incident to guidelines. -
      • Must agree to obtain CPMA auditing certification within 6 to 9-months of employment.
      • Understanding of NCCI and CCI bundling edits, -LCD's, NCDs and other payer coverage policies, and -EOBs and ERA's and denial remarks.
      • Knowledge of CPT and ICD-10 coding, federal and state coding compliance regulations.
      • Detailed knowledge of medical coding systems, procedures and documentation requirements.
      • Proficient with Microsoft programs (Excel, Word) as well as use of overall computer functions.
      • Excellent time management skills with an emphasis on managing changing work priorities.
      • Strong analytical skills such as the ability to identify, research and resolve issues.
        Modernizing Medicine Benefit Highlights:
        • Health Insurance, 401(k), Vacation, Employee Assistance Program, Flexible Spending Accounts
        • Employee Resource Groups -
        • Professional development opportunities including tuition reimbursement programs and unlimited access to -LinkedIn Learning
        • Weekly catered breakfast and lunch, treadmill workstations, quarterly onsite massages, onsite dry cleaning, onsite car wash and many more!

Keywords: SUMMIT PARTNERS, Boca Raton , Medical Coding Auditor, Healthcare , Boca Raton, Florida