Professional Fee Coding Auditor

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

📋 Description

• Conduct independent audits of inpatient and outpatient professional-fee coding to ensure accuracy, documentation support, compliance, and assess reimbursement implications.

• Assess ICD-10-CM, CPT, HCPCS Level II, evaluation and management, modifiers, professional-component, and bundling assignments.

• Validate provider details, scope of practice, billability, and documentation support for the reported professional services.

• Detect incorrect, missing, unbundled, upcoded, downcoded, unsupported, or otherwise noncompliant codes and modifiers.

• Examine diagnoses and procedures within the electronic health record and approved audit tools, adhering to established sampling criteria.

• Record findings along with supporting authority, financial consequences, risks, and suggested corrective actions.

• Maintain an audit accuracy rate of at least 95 percent and engage in calibration activities.

• Assist in the development of audit work plans, data collection tools, facility reports, consolidated reports, and progress updates.

• Discuss preliminary findings with HIMS leadership, the COR, management, and designated facility staff.

• Draft or assist in final reports covering accuracy, documentation concerns, financial impact, process enhancement, and educational requirements.

• Create and deliver facility-specific coding education and facilitate exit conferences.

• Safeguard VA information, adhering to privacy, information security, encryption, and remote work protocols.

• Comply with assigned audit schedules, reporting timelines, training obligations, credential mandates, and access requirements.

⛳️ Requirements

• Must be a U.S. citizen.

• Proficient in reading, writing, speaking, and understanding English.

• Possession of an active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.

• Minimum of two years of coding experience in the relevant coding specialty.

• At least three years of consulting experience in reviewing records at large tertiary-care hospitals and outpatient facilities offering primary care and subspecialty services.

• A minimum of three years of experience in education and training.

• Expertise in ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, DRG, modifiers, bundling, reimbursement, documentation, and compliance standards.

• Successful completion of the Low Risk NACI background check process.

• Fulfillment of required VA privacy, information security, and mandatory training.

• Capability to work securely within the United States.

• Ability to sustain an audit accuracy rate of no less than 95 percent.

• Capacity to meet reporting and turnaround time requirements.

• Current resume outlining necessary coding, consulting record review, and educational or training experience.

• Signed Letter of Intent and completed candidate cover page.

• Verification of an active accepted AHIMA or AAPC credential.

• Two current client references specific to the individual reviewer.

• Results from OIG exclusion search and any requested background, security, identification, privacy, training, or onboarding documents.

🏝️ Benefits

• Competitive salary and benefits packages.

• Fully remote work option available within the United States.

• Remote work schedules aligned with assignment requirements.

• Provision of approved equipment, software, encoder tools, internet access, reference materials, and a secure workspace for remote operations.