UNM Medical Group, Inc.
Medical Coding Auditor
UNM Medical Group, Inc., Albuquerque, New Mexico, United States, 87101
Overview
UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. Responsibilities
Audit medical charts and records for compliance with federal coding regulations and guidelines. Review evaluation and management codes, medical diagnoses, and clinical procedures to ensure accurate billing conforms with legal and regulatory requirements. Train, instruct, and provide technical support to medical providers, support staff, and medical coding personnel on documentation and coding standards. Collaborate with hospital compliance and coding staff to ensure consistent provider education on professional and facility services. Develop, modify, and implement procedures, systems, and protocols to align with UNM Medical Group billing requirements and compliance standards. Assist management with the annual work plan and risk assessment; evaluate external payer record requests for reconsideration, appeals, and rebuttals. Audit documentation to identify undercoded and overcoded services; provide follow-up education and training as needed. Review billing processes for accurate reimbursement and compliance with policies, including unbundling and potentially questionable practices. Respond to internal and external inquiries regarding compliance, coding, denials, and billable services. Interact with physicians, care providers, and staff to clarify documentation and regulatory provisions; ensure compliance with third-party payer requirements. Attend coding conferences and training to stay updated on coding and auditing changes. Maintain strict confidentiality of medical and financial records. Minimum Job Requirements
High School diploma or GED with 5 years of directly related experience; at least one of the following certifications: CPC, CCS-P, COC, RHIA, RHIT, CCs, CHONC. Certification or certificate eligibility for Certified Professional Medical Auditor (CPMA). A completed degree from an accredited institution that exceeds the minimum education requirement may be substituted for experience on a year-for-year basis. Verification of education and licensure will be required if selected for hire. The UNM Medical Group Coding Auditor position requires either holding a CPMA designation at the time of hire or obtaining it within 18 months of hire. UNMMG will pay for study materials and one exam, through the UNMMG Compliance Department budget. Duties and Responsibilities
Audit medical record documentation to identify undercoded and overcoded services; prepare reports and observations; meet with providers and staff to educate on accurate documentation and coding practices; provide follow-up audits as needed. Review billing processes to ensure accurate reimbursement and compliance with policies, including review of unbundling and other potentially questionable practices. Research, analyze, and respond to inquiries regarding compliance, inappropriate coding, denials, and billable services. Interact with physicians and coding personnel regarding billing and documentation policies; obtain clarification on ambiguous documentation. Train staff on documentation, regulatory provisions, and payer requirements. Adapt client procedures and data management systems to meet professional and facility billing requirements. Assist management in formulating the annual work plan and audit protocols to address risks. Assist in reviewing external payer requests, including Medicare Advantage and RAC actions. Collaborate with hospital compliance and coding staff to ensure accurate provider education for professional and facility services. Ensure confidentiality of medical and financial records. Benefits
Competitive salary and comprehensive benefits package. Medical, dental, vision, and life insurance. Tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.
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UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. Responsibilities
Audit medical charts and records for compliance with federal coding regulations and guidelines. Review evaluation and management codes, medical diagnoses, and clinical procedures to ensure accurate billing conforms with legal and regulatory requirements. Train, instruct, and provide technical support to medical providers, support staff, and medical coding personnel on documentation and coding standards. Collaborate with hospital compliance and coding staff to ensure consistent provider education on professional and facility services. Develop, modify, and implement procedures, systems, and protocols to align with UNM Medical Group billing requirements and compliance standards. Assist management with the annual work plan and risk assessment; evaluate external payer record requests for reconsideration, appeals, and rebuttals. Audit documentation to identify undercoded and overcoded services; provide follow-up education and training as needed. Review billing processes for accurate reimbursement and compliance with policies, including unbundling and potentially questionable practices. Respond to internal and external inquiries regarding compliance, coding, denials, and billable services. Interact with physicians, care providers, and staff to clarify documentation and regulatory provisions; ensure compliance with third-party payer requirements. Attend coding conferences and training to stay updated on coding and auditing changes. Maintain strict confidentiality of medical and financial records. Minimum Job Requirements
High School diploma or GED with 5 years of directly related experience; at least one of the following certifications: CPC, CCS-P, COC, RHIA, RHIT, CCs, CHONC. Certification or certificate eligibility for Certified Professional Medical Auditor (CPMA). A completed degree from an accredited institution that exceeds the minimum education requirement may be substituted for experience on a year-for-year basis. Verification of education and licensure will be required if selected for hire. The UNM Medical Group Coding Auditor position requires either holding a CPMA designation at the time of hire or obtaining it within 18 months of hire. UNMMG will pay for study materials and one exam, through the UNMMG Compliance Department budget. Duties and Responsibilities
Audit medical record documentation to identify undercoded and overcoded services; prepare reports and observations; meet with providers and staff to educate on accurate documentation and coding practices; provide follow-up audits as needed. Review billing processes to ensure accurate reimbursement and compliance with policies, including review of unbundling and other potentially questionable practices. Research, analyze, and respond to inquiries regarding compliance, inappropriate coding, denials, and billable services. Interact with physicians and coding personnel regarding billing and documentation policies; obtain clarification on ambiguous documentation. Train staff on documentation, regulatory provisions, and payer requirements. Adapt client procedures and data management systems to meet professional and facility billing requirements. Assist management in formulating the annual work plan and audit protocols to address risks. Assist in reviewing external payer requests, including Medicare Advantage and RAC actions. Collaborate with hospital compliance and coding staff to ensure accurate provider education for professional and facility services. Ensure confidentiality of medical and financial records. Benefits
Competitive salary and comprehensive benefits package. Medical, dental, vision, and life insurance. Tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.
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