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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in coding guidelines, quality assurance audits, and compliance processes, with a strong focus on ICD-10-CM, HCPCS, and CPT coding. Proven ability to analyze coding denials and provide effective feedback to enhance coding accuracy and compliance.
Highest-signal resume keywords
ICD-10-CM CodingHCPCS CodingCPT Procedural CodingQuality Assurance AuditsCoding Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Coding ReviewsDenial Management CodingCompliance AuditsStatistical AnalysisCoding Guidelines Maintenance
Soft Skills
CollaborationCommunicationFeedback Provision
Certifications & Qualifications
Coding Certification
Industry Keywords
Federal Coding GuidelinesState Coding GuidelinesPayer-Specific Coding GuidelinesRAC AuditsCERT Audits
About the role
Key responsibilities & impact- Analyze, review, and provide feedback during quality assurance activities and QA audits
- Ensure federal, state, and payer coding guidelines and regulations are met
- Provide feedback to global coding teams to support successful coding of BOOST clients
- Maintain communication logs documenting global coding team training
- Report coding trends and issues to the department lead
- Review target cases each month according to the ModMed Quality Assurance SOP
- Document daily audit results in the Daily Audit Log
- Communicate coding resolutions to BOOST and global coding teams
- Assist with monthly QA audit log summary pages detailing global coding accuracy levels
- Collaborate on inquiries, clarifications, QA rebuttals, and training requests
- Work with coding leadership on training covering coding processes, documentation, coding guidelines, and QA findings
- Participate in remote coding sessions and sync or committee calls
- Support communications between internal BOOST RCM teams and the Auditing team
- Perform special BOOST quality assurance audits, including assignment accuracy and coding appeals accuracy
- Perform BOOST or Compliance audits when requested
- Support review, appeal, and follow-up of third-party audits such as RAC and CERT
- Assist with maintaining coding guidelines, coding scrub edits, and practice coding instructions
- Support continuous quality improvement and implementation of coding protocols and procedures
- Collaborate with coding and auditing team members to maintain department compliance and effectiveness
Requirements
What you’ll need- Maintain coding certification(s) through continuing education units (CEU)
- Knowledge of ICD-10-CM, HCPCS, CPT procedural coding, modifier usage, and federal, state, and payer-specific coding guidelines
- Ability to conduct coding reviews, quality assurance audits, denial management coding, and compliance audits
- Ability to analyze coding denials and provide claim corrections when applicable
- Ability to provide statistical and qualitative feedback to coding teams
- Ability to collaborate with internal and global coding teams on inquiries, clarifications, QA rebuttals, and training requests
- Ability to review and maintain coding guidelines, coding scrub edits, and practice coding instructions
- Ability to support third-party audits, including RAC and CERT audits
Benefits
Comp & perks- Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution
- 401(k) matching contribution of 50% of employee contributions deferred on up to 6% of compensation; matching contributions vest fully after one year
- Generous Paid Time Off
- Paid Parental Leave programs
- Company-paid Life and Disability benefits
- Flexible Spending Account
- Employee Assistance Programs
- Company-sponsored Business Resource & Special Interest Groups
- Professional development opportunities
- Tuition reimbursement programs
- Unlimited access to LinkedIn Learning
- Global presence and in-person collaboration opportunities
- Dog-friendly headquarters
- Weekly catered breakfast and lunch
- Treadmill workstations
- Zen and wellness rooms
- Remote availability for some roles