Rcm Coding Specialist

Summary

Join Modernizing Medicine (ModMed) as a Medical Coding Quality Auditor 3! This key role within ModMed India Operations involves auditing the work of Global Partners, providing timely feedback on denied coding claims, and serving as a coding subject matter expert. You will review claims, analyze coding denials to identify trends, and participate in coding educational opportunities. The position requires 5+ years of medical coding experience, including 2+ years as a SME/Quality Auditor with multi-specialty experience, and CPC certification. ModMed offers a competitive benefits package including comprehensive insurance, paid time off, parental leave, and wellness allowances in India, and additional benefits such as 401k matching, paid time off, and professional development opportunities in the US.

Requirements

• 5+ years of working experience in medical coding domain where minimum 2 years’ experience as SME/Quality in coding with Multi speciality experience
• Certification Mandatory - CPC
• Hands on knowledge of Coding Denials on providing the resolution
• Good knowledge of Payer Guidelines to resolve the Denials related to Coding
• Good writing and Verbal communication in English
• Can work independently during the India Night Shift
• Can run reports and analyze the trends and scenarios. A strong hand in MS Excel will be a plus
• Expert in supplying/auditing/ analyzing the CPT, ICD Codes along with appropriate Modifiers
• CPC from AAPC or CCS from AHIMA
• Bachelors or Masters in Science with a background of Anatomy

Responsibilities

• Audit the work done by Global Partners and provide timely feedback to teams to aid in the quick resolution of denied coding claims
• Review & work on Coding denials from the Payers
• Serve as a point of contact as coding SME for coding questions and clarifications for the MMI team
• Review claims assigned to practices due to Coding issues in order to find out any trends and will work with CAs if practice education/ intervention is required
• Analyse coding denials to determine trends where preventive measures can be placed, such as scrub edits, provider training, action plans, coder training, etc
• Participates in coding educational opportunities (webinars, internal training, etc.). Will keep updated on the Payer Guidelines impacting on supplying the Codes
• If needed, may assist in the production coding of clients of various specialties and scopes of coding

Preferred Qualifications

Having strong knowledge in Gastro, Orthopaedics, Ophthalmology, Dermatology and Podiatry is preferred

Benefits

• Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk
• Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees
• Allowances: Annual wellness allowance to support your well-being and productivity
• Earned, casual, and sick leaves to maintain a healthy work-life balance
• Bereavement leave for difficult times and extended medical leave options
• Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave
• Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind
• 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 Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed
• Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning
• 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