Remote Risk Adjustment Auditor Jobs in 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*

*This position requires extensive knowledge and experience with E/M coding.

*$4,000 Sign-on Bonus*

Minimum $56,173 - Midpoint $70,217*

*Salary is determined based on years of total relevant experience.

*Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.

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). 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.

*Must have E/M Coding experience

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.

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 package.
• Insurance Coverage: Includes medical, dental, vision, and life insurance.
• Additional Perks: Offers tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.