Careers At UNM Medical Group

Medical Coding Auditor

Department: Compliance
Location: Albuquerque, NM

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.

*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, and/or 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). 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:

  1. 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 necessary.
  2. Reviews billing processes to ensure accurate reimbursement and compliance with regulatory and procedural policies including unbundling and other questionable practices.
  3. Researches, analyzes and responds to internal and external inquiries regarding compliance, inappropriate coding, denials and billable services.
  4. Interacts 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 documentation.
  5. Trains, instructs and/or provides medical providers, support staff and coding personnel as appropriate regarding documentation, regulatory provisions and third party payer requirements.
  6. Reviews, develops, modifies, and/or adapts relevant client procedures, protocols and data management systems to ensure that client billing requirements are met for professional and facility services.
  7. Assists management in the formulation of the annual work plan and formulates audit protocol to capture risks in audit schedule.
  8. Assists 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 actions.
  9. Collaborates with hospital compliance and coding staff to ensure that provider education and training for professional and facility services is accurate and consistent.
  10. Ensures strict confidentiality of medical and financial records.
  11. .Attends coding conferences, workshops and in-house sessions to receive updated coding and auditing information and changes to regulations.
  12. Performs miscellaneous job related duties as assigned.

About UNM Medical Group, Inc.

UNM Medical Group, Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. UNMMG is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG strives to mitigate health disparities brought about by technology; we aim to reach underrepresented populations, making healthcare more equitable and accessible for all of the people in New Mexico; we have a demonstrated commitment to diversity, equity, inclusion, and student success as well as working with broadly diverse communities.

Benefits:

UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, generous paid time off plan and 403b retirement for benefits eligible employees.

Apply to our Medical Coding Auditor opportunity with UNM Medical Group, Inc. and a recruiter will contact you shortly!

Notice of Equal Opportunity Employment

We are an equal opportunity employer/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, national origin, sexual orientation, gender identity, marital status, disability, protected veteran status, or any other characteristic protected by law. We are a drug and alcohol free employer.

We are committed to providing reasonable accommodations to individuals with disabilities in the employment application process. If you need an accommodation due to disability to use our online system to apply with the UNM Medical Group, send an email to accommodations@unmmg.org.

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