Modernizing Medicine, Inc. is hiring a Medical Coding Auditor

Modernizing Medicine, Inc. is looking for a Medical Coding Auditor to join our team. In this role, you will conduct coding reviews and quality assurance audits to verify coding guidelines are followed. You will also perform denial management coding, review denials, provide corrections, and perform QA on global denial coding processes. Under the supervision of the Medical Coding and Auditing Manager, you will provide essential feedback and education to our coding teams.

What You'll Do

• Conduct coding reviews and quality assurance audits to verify ICD-10-CM, HCPCS, CPT procedural coding, and modifier usage guidelines are followed.
• Perform as a denial management coder, reviewing and analyzing coding denials and providing needed corrections.
• Perform quality assurance on the global denial coding teams' processes.
• Maintain continuous contact with internal and global coding teams to provide statistical and qualitative feedback on coding quality.
• Aid in education and guidance consistent with established coding and compliance guidelines.
• Analyze, review, and provide feedback when performing quality assurance activities and completing QA audits.
• Ensure 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 clients.
• Maintain 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 daily audit results in the Daily Audit Log and communicate coding resolutions to the 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.
• Attend remote coding sessions with the global coding teams.
• Help with daily communications between the internal RCM teams and the Auditing team regarding other coding inquiries or issues.
• Perform special Quality Assurance audits on the global coding teams.
• Perform Compliance audits when requested 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.
• 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.
• Obtain continuing education units (CEU) for maintaining coding certification(s).

What We're Looking For

• Minimum 1-year experience as a Certified Professional Coder - physician-based and/or ASC-based.
• Knowledge of CPT, ICD-10 CM, HCPCS, CPT coding, modifiers, E/M and all coding guidelines.
• Knowledge of medical terminology and anatomy.
• Understanding of federal, state and local coding compliance regulations and guidelines.
• Understanding of NCCI and CCI bundling edits.
• Understanding of LCD’s, NCDs and other payer coverage policies.
• Detailed knowledge of medical coding systems, procedures and documentation requirements.
• Ability to interpret and apply coding guidelines for federal, state, and local standards.
• Must agree to obtain CPMA auditing certification within 6 months of employment (if not a CPMA already).

Nice to Have

• Multi-specialty coding experience.
• Minimum 1-year experience as a Certified Professional Medical Auditor (CPMA).
• Understanding of EOBs and ERA’s, denial remarks and claims review.
• Detailed knowledge of medical billing.
• Proficient with Microsoft programs (Excel, Word) as well as use of overall computer functions.
• Experience in gMed/gGastro or EMA/PM.

Team & Environment

You will join the BOOST Services team, reporting to the Medical Coding and Auditing Manager, as part of our 4,500+ person mission-driven company.

Benefits & Compensation

• Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution.
• 401(k) matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation (100% vested after one year).
• 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.
• 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.

Work Mode

This is a hybrid role based in Boca Raton, Florida.

We are an equal opportunity employer.