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Medical Coding Auditor

United States

At Modernizing Medicine, we look for passionate, innovative, creative Rock Stars!

• South Florida Business Journal, Business of the Year 2022
• BIG Awards for Business, Company of the Year 2021
• Best in Biz Award (Silver), Fastest-Growing Company of the Year 2021
• South Florida Business Journal, Best Places to Work 2021
• Inc. Magazine Best Workplaces of 2020

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. The Medical Coding Auditor 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 RCM Coding Auditor, HCPCS, modifier usage and procedure coding are being followed by the RCM Coding Team. The RCM Coding Auditor also performs as a denial management coder which reviews and analyzes assigned coding denials and/or correction of these claims when applicable. The RCM 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 RCM Coding Auditor performs duties under the supervision of the RCM Medical Coding and Auditing Supervisor and related to the product(s) to which they are assigned.

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 if needed
• Advise RCM staff and department leadership on issues related to client’s coding or documentation compliance
• Report all coding trends and issues to department lead as they are identified
• Verify medical necessity for proper payment of claims
• 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
• Assist with continuous quality improvement by helping with the process of implementation and carry through of coding protocols and procedures
• Constructive collaboration with fellow coding/auditing team members to maintain department compliance and effectiveness
• Responsible for obtaining continuing education units (CEU) for maintaining coding certification(s)
• Perform other job duties and projects as assigned

Quality Assurance Auditing Functions

• When working on Quality Assurance activities the Revenue Cycle Coding Auditor is responsible for analyzing, reviewing and providing feedback on QA audits performed
• Ensuring all federal and state coding guidelines and regulations are met as well as payer guidelines
• Provide effective feedback to the Global Services Team to aid in their successful coding of RCM contracted coding clients
• Maintaining a communication log to show successful training of the Global Services Team when coding trends or issues are found
• 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 RCM or Global Services Team
• This would include monthly assistance in maintaining QA audit logs summary pages which details Global Services Teams (coders/auditors) monthly coding accuracy levels
• Working alongside coding leadership in regards to Global Services Team training of coding processes as well as attending remote coding sessions with Global Services Team
• Help with other daily communications between RCM team and Auditing team in regards to other coding inquires or issues
  • This would include any sync calls pertaining to assigned clients or ModMed committee calls pertaining to assigned specialities
• Perform RCM or Compliance audits when requested by RCM or other ModMed staff which help to determine coding compliance or client documentation issues

Denial Management Auditing Functions

• Work as an effective denial management coder and assist with resolving reimbursement and denial issues related to coding inaccuracies or insufficiencies
• Review target cases per month based on the ModMed Denial Management SOP
• 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
• Accurately document review results and resolutions in the Daily Review Log and communicate coding resolutions to RCM team
  • Aid in the RCM communication processes which includes advising RCM staff of any coding issues or trends pertaining to client denials or documentation issues
• Help with other needed daily communications between RCM team and Auditing team in regards to other types of coding inquires or issues
  • This would include any sync calls pertaining to assigned clients or ModMed committee calls pertaining to assigned specialities
• 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) required
• Certification in one or more of the following:
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)
  • Certified Coding Specialist-Physician (CCS-P)
• Minimum 2 years experience as a certified medical coder – physician based and/or ASC based
• Minimum 1 year experience as a certified medical auditor is preferred
• Must be knowledge in E/M coding – Office/Outpatient and Inpatient and Incident to guidelines
• Knowledge of CPT and ICD-10 coding, federal and state coding compliance regulations
• Knowledge of medical terminology and anatomy
• Understanding of NCCI and CCI bundling edits
• Understanding of EOBs and ERA’s and denial remarks
• Detailed knowledge of medical billing is preferred
• Proficient with Microsoft programs (Excel, Word) as well as use of overall computer functions
• Experience in gMed/gGastro or EMA/PM is preferred but not required
• 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!