Medical Coding Auditor

ModMed is hiring a driven Medical Coding Auditor to join their BOOST Services team, focusing on coding compliance, quality assurance, and audit processes within a healthcare IT environment. The role involves reviewing coding accuracy, providing feedback, and supporting audit and denial management to uphold high standards in medical coding.

Location: United States

Responsibilities

• Analyzing, reviewing, and providing feedback on quality assurance activities and audits, including ensuring compliance with federal, state, and payer guidelines.
• Reviewing target cases per month based on SOP.
• Documenting audit results and communicating coding resolutions.
• Collaborating with global coding teams on inquiries, clarifications, and training.
• Participating in training sessions and remote coding sessions.
• Performing special QA audits and compliance audits.
• Supporting review, appeal, and follow-up of third-party audits.
• Maintaining coding guidelines and participating in quality improvement.
• Obtaining continuing education units for certification maintenance.

Requirements

• Minimum 1-year experience as a Certified Professional Coder (CPC), physician-based and/or ASC-based, multi-specialty coding experience preferred.
• Minimum 1-year experience as a Certified Professional Medical Auditor (CPMA), preferred.
• Must agree to obtain CPMA certification within 6 months if not already certified.
• Knowledge of CPT, ICD-10 CM, HCPCS, modifiers, E/M, and coding guidelines.
• Knowledge of medical terminology and anatomy.
• Understanding of coding compliance regulations, NCCI, CCI, LCDs, NCDs, payer policies, EOBs, ERAs, and claims review.
• Experience with medical billing and coding systems.
• Strong attention to detail, communication, analytical, and time management skills.

Benefits

• Comprehensive medical, dental, and vision benefits.
• 401(k) with matching contributions.
• Paid Time Off and parental leave.
• Life and disability benefits, FSA, Employee Assistance Programs.
• Professional development including tuition reimbursement and LinkedIn Learning.
• Global presence with collaboration opportunities.
• Office amenities including catered meals, wellness rooms, and treadmill workstations.