Medical Coding Auditor

At
** Mod Med**, we’re not just building software—we’re reimagining the healthcare experience. Founded in 2010 by a practicing physician and a successful tech entrepreneur, we took a radically different approach:
** we hired doctors and taught them how to code.
** This "for doctors, by doctors" philosophy has allowed us to create an AI-enabled, specialty-specific cloud platform that places patients at the center of care.
* 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 Mod Med 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 Mod Med 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)
* 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
* Ability to interpret and apply coding guidelines for federal, state, and local standards, required
* Proficient with Microsoft programs (Excel, Word) as well as 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
* Comprehensive medical, dental, and vision benefits, including a…