Pro Fee Quality Team Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Support the onboarding and training of pro fee reviewers on resource tools, facility-guideline drives, OneNote, Replicon, the education portal, policies and procedures, as well as client-specific guidelines.

• Develop training workflows and related materials for client reviews as necessary.

• Work in collaboration with coding operations leaders to manage pro fee QA pre-bill assignments.

• Assist in ensuring reviewer connectivity for both new and existing clients while troubleshooting issues with the review team.

• Partner with onshore and offshore coding leadership to update and disseminate the pro fee review assignment sheet on a weekly basis.

• Conduct thorough reviews of patient record documentation for audited dates of service to confirm code and abstract data accuracy.

• Validate necessary code elements.

• Perform monthly coding quality reviews for the required number of accounts per coder.

• Identify errors in abstracting, ICD-10-CM, CPT, modifiers, and HCPCS coding.

• Generate coder productivity reports from facility systems or GuideAudit production, or select random sample accounts from completed coding spreadsheets.

⛳️ Requirements

• Must possess one of the following active credentials: CPC, COC, CPMA, RHIT, RHIA, CCS, CIC, or COC.

• A high school diploma or GED is required.

• Relevant experience may be accepted in place of a degree.

• Must maintain coding credentials while employed at Guidehouse.

• Must successfully pass the Guidehouse coding competency exam.

• A minimum of 8 years of experience in pro fee coding or review is required.

• Must adhere to all client policies and procedures.

• Must comply with all Guidehouse policies and procedures.

• Proficiency in Microsoft Office, Excel, computer programs, and company-specific software is necessary.

• Experience in auditing is preferred.

• Previous leadership experience is a plus.

• A BS/BA degree is preferred.

🏝️ Benefits

• Medical, Rx, Dental & Vision Insurance.

• Personal and Family Sick Time & Company Paid Holidays.

• The position may qualify for a discretionary variable incentive bonus.

• Parental Leave.

• 401(k) Retirement Plan.

• Basic Life & Supplemental Life Insurance.

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts.

• Short-Term & Long-Term Disability Insurance.

• Tuition Reimbursement, Personal Development & Learning Opportunities.

• Skills Development & Certifications.

• Employee Referral Program.

• Corporate Sponsored Events & Community Outreach.

• Emergency Back-Up Childcare Program.

• Flexible benefits package.

• Competitive compensation.