Marwood Group · 20 hours ago
Certified Coding Auditor Behavioral Health
New York, NY
Full-time
Hybrid
Senior Level
5+ years expMarwood Group is a healthcare advisory services firm headquartered in New York City, and they are seeking a Certified Coding Auditor to join their team. The role involves performing remote billing and coding audits to ensure compliance with regulations and coverage policies, as well as researching state and payer regulations to identify risk areas in healthcare settings.
Financial Services
Responsibilities
Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payers
Researching state and payer regulations to identify areas of risk in a variety of healthcare settings and specialties, coordinating with various team members to ensure clear expectations are communicated and deadlines are met
Qualification
Required
CPC with a minimum of 5 years of 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
Proven ability to identify billing and coding issues including use of modifiers, bundling issues, CCI edits, therapeutic and diagnostic procedures, supplies, materials, injections, drugs, and units of service etc
Solid understanding of both federal and state coding and documentation laws and regulations, applicable fraud statutes, and regulations, and of federal guidelines on recoupments and other anti-FWA activity
Familiarity with both UB-04 and CMS 1500 claims data, as well as understanding of payor remittances
Knowledge of anatomy, physiology, and medical terminology necessary to appropriately review assignment and documentation of diagnosis codes
Solid working knowledge of various EHR/EMR systems; experience accessing these remotely
Strong organizational skills and task management
Highly organized with a high level of attention to detail
Ability to work in a fast paced and rapidly changing environment
Skilled at multi-tasking with the ability to manage several different priorities simultaneously
Strong communication skills with experience in articulating audit findings and interpretation of coding regulations
Experience with HIPAA, data privacy, and/or data security processes
Experience working with regulators governing (public or private) health insurance carriers
Preferred
Inpatient psych experience preferred
Certifications that are applicable to this work include: Certified Outpatient Coder (COC™), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC™), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician based (CCS-P)
Benefits
Medical
Dental
Vision
Life
AD&D
Voluntary Life
LTD
Spouse and Dependent Life
401k Retirement plan with a company match
Commuter
FSA/DCFSA
Paid days off
Paid holidays
Company
Marwood Group
Marwood Group is a strategic advisory and financial services firm headquartered in New York City.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Ritu Nalubola
Director, Life Sciences and Healthtech
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