Medical Coding Auditor - Must have a NM Residence

Job summary

Albuquerque

Medical Coding

Work model

Hybrid · 5 days home

3 days ago

Job description

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 Sign On Bonus 4000 Minimum 56173 Midpoint 70217 Salary is determined based on years of total relevant experience Salary is based on 10 FTE full time equivalent or 40 hours per week Less than 40 hoursweek will be prorated and adjusted to the appropriate FTE This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico Summary Under indirect supervision audits medical charts and records for compliance with federal coding regulations and guidelines Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and management codes medical diagnoses and clinical procedures ensuring that accurate medical billing conforms with legal and regulatory requirements Trains instructs and provides technical support to medical providers support staff and medical coding personnel on accurate documentation supports billing and coding standards Collaborates with hospital compliance and coding staff to ensure consistent training with medical providers on professional and facility services Reviews develops andor modifies procedures systems and protocols to achieve and maintain compatibility with UNM Medical Group billing requirements and compliance standards Assists management with the development of the annual work plan risk assessment and evaluates external payer record requests for reconsideration appeals and rebuttals Minimum Job Requirements of a Medical Coding Auditor High School diploma or GED with 5 years directly related experience; at least one of the following CPC CCS CCS P COC RHIA or RHIT CHONC Certification or certificate eligible for Certified Professional Medical Auditor CPMA Completed degree from an accredited institution that are above 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 UNMMG Coding Auditor position requires the candidate to either hold a Certified Professional Medical Auditor CPMA designation at the time of hire or to secure such designation within 18 months of hire UNMMG will pay for study materials and the cost of one exam through the UNMMG Compliance Department budget Duties and Responsibilities of a Medical Coding Analyst Audits medical record documentation to identify undercoded and overcoded services prepares reports and observations and meets with providers support staff and coding personnel to provide education and training on accurate documentation and coding practices in compliance with regulatory requirements Provides follow up audits when necessaryReviews billing processes to ensure accurate reimbursement and compliance with regulatory and procedural policies including unbundling and other questionable practicesResearches analyzes and responds to internal and external inquiries regarding compliance inappropriate coding denials and billable servicesInteracts with physicians other patient care providers support staff and coding personnel regarding billing and documentation policies procedures and regulations; obtains clarification on conflicting ambiguous or non specific documentationTrains instructs andor provides medical providers support staff and coding personnel as appropriate regarding documentation regulatory provisions and third party payer requirementsReviews develops modifies andor adapts relevant client procedures protocols and data management systems to ensure that client billing requirements are met for professional and facility servicesAssists management in the formulation of the annual work plan and formulates audit protocol to capture risks in audit scheduleAssists management in the review of external payer requests including but not limited to third party payers Medicare Advantage plans and Recovery Audit Contractor reviews for reconsideration appeal and rebuttal actionsCollaborates with hospital compliance and coding staff to ensure that provider education and training for professional and facility services is accurate and consistentEnsures strict confidentiality of medical and financial recordsAttends coding conferences workshops and in house sessions to receive updated coding and auditing information and changes to regulationsWhy Join UNM Medical Group Inc Since our creation in 2007 our dynamic organization has continued to grow and form strong partnerships within the UNM Health system We ASPIRE to incorporate the following values into all aspects of our culture and work we always demonstrate an Attitude of Service with Positivity Integrity and Respect as we strive for Excellence Why Join UNM Medical Group Inc Since our creation in 2007 our dynamic organization has continued to grow and form strong partnerships within the UNM Health system Modern Healthcare recognizes UNMMG in their Best Places to Work recognition for 2025 We ASPIRE to incorporate the following values into all aspects of our culture and work we always demonstrate an Attitude of Service with Positivity Integrity and Respect as we strive for Excellence We are dedicated to embracing and promoting diversity while fostering well being across New Mexico through cultural humility and respect for everyone Benefits Competitive Salary & Benefits UNMMG provides a competitive salary along with a comprehensive benefits packageInsurance Coverage Includes medical dental vision and life insuranceAdditional Perks Offers tuition reimbursement generous paid time off and a 403b retirement plan for eligible employees

More Home office jobs in Medical Coding

Health Information Management Specialist

CenterWell

Join Humana as a Medical Records Clerk! Assemble & maintain patient health info, ensure accuracy, and communicate with staff. Apply now!

Hybrid· Atlanta

2 days ago

Medical Director-Payment Integrity

Humana

**Become a part of our caring community** The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the Inpatient level. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid, and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work and communication of decisions to internal associates. The clinical scenarios predominantly arise from inpatient or post-acute care environments. A remote possibility exists of doing peer-to-peer discussions with an external provider. Some roles include an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, and outpatient services and equipment, within their scope. Medical Directors support Humana values, and Humana's mission, throughout all activities. **Use your skills to make an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Lead Medical Director. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. Supports the assigned work with respect to market-wide objectives and community relations as directed. **Required Qualifications** * MD or DO degree * 5 years of direct clinical patient care experience post residency or fellowship, which preferably includes experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). * Current and ongoing Board Certification an approved ABMS Medical Specialty * A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. * No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. * Excellent verbal and written communication skills. * Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation. **Preferred Qualifications** * Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. * Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. * Experience with national guidelines such as MCG® or InterQual * Internal Medicine, Hospitalist, Family Practice, Geriatrics, Emergency Medicine clinical specialists * Advanced degree such as an MBA, MHA, MPH * Exposure to Public Health, Population Health, analytics, and use of business metrics. * The curiosity to learn, the flexibility to adapt and the courage to innovate **Additional Information** Typically reports to a Lead Medical Director. The Medical Director conducts post-service, inpatient care reviews for accurate billing of clinically valid diagnoses and care received. May also engage in disputes and grievance and appeals reviews. May participate on project teams or organizational committees. #physiciancareers Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-29-2026 **About us** About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health -- delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Hybrid· Frankfort

3 days ago

View all Home office jobs in Medical Coding