The Marwood Group, a NYC based healthcare consulting firm, is looking for candidates to join its Clinical and Compliance Team
Coding Audit Associate
- Full Time Position NYC based or work
remotely
- Perform remote billing and coding
audits to ensure client coding practices are compliant with regulations
and coverage policies for both government and commercial payers
Minimum Qualifications:
CPC with a minimum 5 years’ experience in
healthcare coding/auditing (E&M, CPT, HCPCS and ICD-10,), with knowledge of
professional billing, coding and documentation practices performed by
physicians and other qualified healthcare providers in inpatient and outpatient
settings
• Proficiency in evaluating how well clinical
documentation supports medical necessity and the E/M, CPT and HCPCS codes that
were billed, across a wide range of services, including medical, behavioral
health, chemical dependency, OBGYN, Ophthalmology Dermatology, ASC, Radiology
etc.
• Proven ability to identify billing and
coding issues including use of Modifiers, bundling issues, CCI edits, therapeutic and diagnostic procedures, supplies, materials, injections, drugs,
modifiers, and units of service etc.
• Solid understanding of state and federal
coding, and documentation laws and regulations, applicable fraud statutes and
regulations, and federal guidelines on recoupments and other anti-FWA activity.
Identify and access risk of prepayment or recoupment in the event of payor
scrutiny
• Knowledge of anatomy, physiology, and
medical terminology necessary to appropriately review assignment and
documentation of diagnosis codes
• Familiarity with and ability to work within
EMR systems
• Highly organized with a high level of
attention to detail and task management
• Ability to work in a fast paced and rapidly
changing environment
Additional Desired Skills:
• Additional certification applicable to this
work includes:
- Certified
Outpatient Coder (COC™)
- Certified
Risk Adjustment Coder (CRC™)
• Experience with HIPAA, data privacy, and/or
data security processes
• Experience working with regulators
governing (public or private) health insurance carriers
Compensation package is commensurate with experience.
There is no travel expected with this position.