Medical Coding Auditor

Medical Coding Auditor

Job Description Summary:

Medical Coding Auditors are responsible for ensuring that coding performed on behalf of ModMed BOOST clients is in compliance with all published federal, state and payer-specific coding guidelines.

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 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.

Essential Functions of Medical Coding Auditor

• 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 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
• This would include monthly assistance in maintaining QA audit logs summary pages which details the global coding teams monthly coding accuracy levels
• Collaborate with the global coding teams on inquires, clarifications, QA rebuttals and training requests
• Work alongside coding leadership in regard to global coding teams training of coding processes as well as attending remote coding sessions with the global coding teams
• This would consist of coding, documentation, coding guideline training and overall QA findings resolutions
• Help with other daily communications between the internal BOOST RCM teams and the Auditing team in regards to other coding inquiries or issues
• This would include any sync calls pertaining to assigned clients or ModMed committee calls pertaining to assigned specialties
• Perform BOOST special Quality Assurance audits on the global coding teams
• Such as on their assignment accuracy, coding appeals accuracy and all other coding scopes
• 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)

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.

• We are Modernizing Medicine (WAMM)!

• It takes more than just a great product to modernize medicine. It takes a great team.

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