Physician Coding Auditor
About Us
MedKoder, LLC is a full-service medical coding management services provider based in Mandeville, Louisiana, specializing in expert medical coding for health systems, providers, and payers. Founded and led by a medical coding veteran, the company offers services including inpatient and outpatient facility coding, medical risk adjustment management, DRG coding management, coding education, clinical coding documentation improvement, revenue integrity, and revenue cycle consulting. MedKoder leverages proprietary AI, automated business intelligence, and natural language processing to deliver accurate, efficient, and ethical coding, aiming to ensure accurate payment and financial peace for clients. With a team of certified coders throughout the United States, MedKoder emphasizes coding excellence, remote-work flexibility, and a positive workplace culture, earning high employee satisfaction ratings and awards with Best Places to Work in Modern Healthcare and City Business Best Places to Work. Position Location: 100% Remote
Position Classification:Full-time, 40 hour work weekthat offers a flexible schedule
Description:
Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement. Physician Coding Auditor is expected to adhere to MedKoders internal coding/auditing policies and expectations set forth by department management. Physician Coding Auditor must prioritize daily duties, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals.
Candidates ideally have recent auditing experience specializing in some of the following profee areas: Ophthalmology, Behavioral Health, Cardiovascular/Cardiothoracic Surgery, Complex ENT Surgery, Dental, Complex Plastic Surgery, Orthopedic Surgery, Peds NICU/PICU, and FQHC/RHC.
Responsibilities:
Perform professional compliance audits of coding and documentation including surgeries, visits, and other services for multiple provider types across multiple specialties, for multiple clients;
Accurate application of appropriate coding and documentation guidelines, including ICD-10-CM Guidelines, CPT Coding Guidelines, AHA Coding Clinics, AMA, CMS, Specialty Association/Society guidance, and others, as applicable;
Accurate selection of CPT codes for services performed;
Accurate selection and application of modifiers to CPT codes;
Accurate selection and evaluation of ICD-10-CM diagnosis coding;
Evaluate the overall quality of physician documentation that supports codes selected including adherence to Medical Necessity;
Adherence to Local Coverage Determination (LCDs), or National Coverage Determination (NCDs), if applicable; National Correct Coding Initiative (NCCI) edits, and payor-specific policies, if applicable;
Appropriateness of documentation for split/shared or incident-to services;
Appropriateness of provider documentation related to Teaching Physician Guidelines, FQHCs, RHCs, and HEDIS, as applicable;
Accurately score audits utilizing proper scoring methodology;
Identifies risk areas and provides mitigation strategies and recommendations;
Provide detailed findings for each service reviewed on customized reports, including supporting documentation;
Prepare and present audit follow-up education to clients;
Prepare and present customized education materials based on the unique needs of the client remotely and on-site;
Communicate with the Physician Audit and Education Manager on issues, trends, and audit timeline task completion;
Stay current on all coding guidelines (including specialty-specific guidelines), and maintain credentials as necessary;
Participate in department and education meetings;
Maintain confidentiality and protect sensitive information;
Exhibit professional demeanor and communication (written and verbal);
Other duties as assigned by leadership.
Education/Experience Requirements:
High School diploma required. Associate or BS degree preferred.
Successful completion of at least one AHIMA or AAPC certified program with the achievement of the correlating professional credential (CCS, CPC, etc.); active and in good standing. Successful completion of the AAPC CPMA credential is required; preferably a combination of two or more credentials.
Minimum 5 years of recent physician coding experience and 3 years of recent physician auditing experience are required.
Must be a subject matter expert on E&M and Surgical coding. Must have expert knowledge of medical terminology, anatomy and physiology, disease processes, CPT coding and guidelines by the AMA, ICD-10-CM coding and guidelines, and Medicare and Medicaid billing policies for professional services.
Experience working independently, excellent time management, masterful research and organizational skills, the ability to switch between multiple projects, and the ability to meet project deadlines are a must.
Experience creating and implementing audit plans. Experience educating providers one-on-one or in group settings.
Additional skills required: Proficiency with Microsoft Word, Excel, PowerPoint, Windows, and healthcare information and billing systems.
Experience working with Google Suite is preferred but not required.
Experience working remotely is preferred but not required.
Epic and eClinicalWorks (ECW) experience is a PLUS.
About MedKoder, LLC:
Privately held, growing company with strong values and ethics
Professional development and education
All positions are permanent no contracts or sitting on a coding bench
Generous paid time off, holiday pay, and flexible scheduling year-round
Internal network of Medical Coding Industry Leaders CEO is a Certified Coder with 20+ years of experience
Up to 100% EMPLOYER PAID Medical, Dental, and Vision benefits for employees
401K and Profit Sharing
STD, LTD, Life Insurance, and FSA Program
Paid AAPC and AHIMA corporate memberships
30 Hours of CEU pay (continuance in education)
MedKoder is recognized nationally by Modern Healthcare as Best Place to Work
About the job
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Physician Coding Auditor
About Us
MedKoder, LLC is a full-service medical coding management services provider based in Mandeville, Louisiana, specializing in expert medical coding for health systems, providers, and payers. Founded and led by a medical coding veteran, the company offers services including inpatient and outpatient facility coding, medical risk adjustment management, DRG coding management, coding education, clinical coding documentation improvement, revenue integrity, and revenue cycle consulting. MedKoder leverages proprietary AI, automated business intelligence, and natural language processing to deliver accurate, efficient, and ethical coding, aiming to ensure accurate payment and financial peace for clients. With a team of certified coders throughout the United States, MedKoder emphasizes coding excellence, remote-work flexibility, and a positive workplace culture, earning high employee satisfaction ratings and awards with Best Places to Work in Modern Healthcare and City Business Best Places to Work. Position Location: 100% Remote
Position Classification:Full-time, 40 hour work weekthat offers a flexible schedule
Description:
Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement. Physician Coding Auditor is expected to adhere to MedKoders internal coding/auditing policies and expectations set forth by department management. Physician Coding Auditor must prioritize daily duties, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals.
Candidates ideally have recent auditing experience specializing in some of the following profee areas: Ophthalmology, Behavioral Health, Cardiovascular/Cardiothoracic Surgery, Complex ENT Surgery, Dental, Complex Plastic Surgery, Orthopedic Surgery, Peds NICU/PICU, and FQHC/RHC.
Responsibilities:
Perform professional compliance audits of coding and documentation including surgeries, visits, and other services for multiple provider types across multiple specialties, for multiple clients;
Accurate application of appropriate coding and documentation guidelines, including ICD-10-CM Guidelines, CPT Coding Guidelines, AHA Coding Clinics, AMA, CMS, Specialty Association/Society guidance, and others, as applicable;
Accurate selection of CPT codes for services performed;
Accurate selection and application of modifiers to CPT codes;
Accurate selection and evaluation of ICD-10-CM diagnosis coding;
Evaluate the overall quality of physician documentation that supports codes selected including adherence to Medical Necessity;
Adherence to Local Coverage Determination (LCDs), or National Coverage Determination (NCDs), if applicable; National Correct Coding Initiative (NCCI) edits, and payor-specific policies, if applicable;
Appropriateness of documentation for split/shared or incident-to services;
Appropriateness of provider documentation related to Teaching Physician Guidelines, FQHCs, RHCs, and HEDIS, as applicable;
Accurately score audits utilizing proper scoring methodology;
Identifies risk areas and provides mitigation strategies and recommendations;
Provide detailed findings for each service reviewed on customized reports, including supporting documentation;
Prepare and present audit follow-up education to clients;
Prepare and present customized education materials based on the unique needs of the client remotely and on-site;
Communicate with the Physician Audit and Education Manager on issues, trends, and audit timeline task completion;
Stay current on all coding guidelines (including specialty-specific guidelines), and maintain credentials as necessary;
Participate in department and education meetings;
Maintain confidentiality and protect sensitive information;
Exhibit professional demeanor and communication (written and verbal);
Other duties as assigned by leadership.
Education/Experience Requirements:
High School diploma required. Associate or BS degree preferred.
Successful completion of at least one AHIMA or AAPC certified program with the achievement of the correlating professional credential (CCS, CPC, etc.); active and in good standing. Successful completion of the AAPC CPMA credential is required; preferably a combination of two or more credentials.
Minimum 5 years of recent physician coding experience and 3 years of recent physician auditing experience are required.
Must be a subject matter expert on E&M and Surgical coding. Must have expert knowledge of medical terminology, anatomy and physiology, disease processes, CPT coding and guidelines by the AMA, ICD-10-CM coding and guidelines, and Medicare and Medicaid billing policies for professional services.
Experience working independently, excellent time management, masterful research and organizational skills, the ability to switch between multiple projects, and the ability to meet project deadlines are a must.
Experience creating and implementing audit plans. Experience educating providers one-on-one or in group settings.
Additional skills required: Proficiency with Microsoft Word, Excel, PowerPoint, Windows, and healthcare information and billing systems.
Experience working with Google Suite is preferred but not required.
Experience working remotely is preferred but not required.
Epic and eClinicalWorks (ECW) experience is a PLUS.
About MedKoder, LLC:
Privately held, growing company with strong values and ethics
Professional development and education
All positions are permanent no contracts or sitting on a coding bench
Generous paid time off, holiday pay, and flexible scheduling year-round
Internal network of Medical Coding Industry Leaders CEO is a Certified Coder with 20+ years of experience
Up to 100% EMPLOYER PAID Medical, Dental, and Vision benefits for employees
401K and Profit Sharing
STD, LTD, Life Insurance, and FSA Program
Paid AAPC and AHIMA corporate memberships
30 Hours of CEU pay (continuance in education)
MedKoder is recognized nationally by Modern Healthcare as Best Place to Work