At **ModMed**, 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 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* 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 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)* 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 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 that provide engaged and supportive communities within ModMed,* Professional development opportunities, including tuition reimbursement programs and unlimited access to ,* 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.### Get In TouchIntroduce yourself to our recruiters and we'll get in touch if there's a role that seems like a good match.
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