Senior Consultant – Profee Auditor, Quality and Education

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

📋 Description

• Conduct coding audits on various professional fee medical records.

• Apply and improve professional fee auditing and coding expertise.

• Independently investigate complex coding scenarios and substantiate audit conclusions with coding and regulatory references.

• Convert audit insights and patterns into clear, actionable training materials.

• Offer personalized feedback and one-on-one coaching to internal coders and auditors.

• Engage in peer reviews, audit-the-auditor sessions, calibration, and various quality assurance initiatives.

• Convey audit results, coding justifications, training, and constructive feedback to coders, auditors, and leadership.

• Manage multiple tasks and deadlines in a fast-paced, quality-focused environment.

• Conclude and present unbiased, objective audit results.

• Work remotely while adapting to shifting priorities.

⛳️ Requirements

• Active certification from AHIMA or AAPC, such as CPC, CPMA, CCS-P, or COC.

• A minimum of 3-5 years of practical experience in professional fee coding and medical record auditing within a multi-specialty or hospital-affiliated environment.

• Experience across a range of medical specialties, including Emergency Department, Hospitalist, Primary Care, ENT, Nephrology, Urology, Cardiology, Thoracic, Neurology, Obstetrics and Gynecology, Behavioral Health, Ophthalmology, Endocrinology, etc.

• Advanced understanding and proven auditing experience in the full spectrum of professional coding, including ICD-10-CM diagnosis coding, CPT, HCPCS, modifiers, E/M leveling, and procedural coding.

• Strong knowledge of professional coding guidelines, CPT conventions, CMS regulatory requirements, NCCI edits, and other relevant professional fee coding and billing practices.

• Capability to independently examine complex coding situations and interpret authoritative coding guidelines, including Official Coding Guidelines, Medicare/Medicaid Claims Processing Manual, OIG guidance, LCD/NCD documents, and transmittals.

• Skill in translating audit findings and identified patterns into clear, actionable training and providing personalized feedback along with one-on-one coaching.

• Experience in participating or assisting in peer reviews, audit-the-auditor sessions, calibration, and other quality assurance activities.

• Strong computer proficiency, including familiarity with EHR systems such as EPIC and Cerner, automated auditing tools, and secure file transfer in accordance with HIPAA regulations.

• Excellent verbal and written communication abilities.

• Strong organizational and time-management skills; adept at prioritizing competing tasks, meeting deadlines, and upholding quality and productivity standards.

• Ability to remain impartial and objective when finalizing and presenting audit findings.

🏝️ Benefits

• Medical, Dental, Vision, and Life Insurance.

• Short-term and long-term disability coverage.

• Paid Time Off (PTO).

• 401(K) plan.

• Referral bonuses.

• Opportunities for training.

• Annual educational allowances.

• Continuing education programs.

• Dedicated support team for guidance and mentoring.

• Recognition for birthdays.

• Holiday gift selections.

• Years of service awards.

• Quality bonus programs.

• Career growth and development opportunities.

• Dynamic work environment.