Senior Consultant, Profee Auditor, Quality and Education

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

📋 Description

• Conduct coding audits on a diverse range of professional fee medical records.

• Perform independent research on intricate coding scenarios and substantiate audit results with coding regulations and guidelines.

• Convert audit outcomes and patterns into straightforward, actionable educational content.

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

• Engage in or assist with peer reviews, audit-the-auditor processes, calibration, and other quality assurance initiatives.

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

• Juggle multiple tasks and deadlines while upholding quality and productivity benchmarks.

⛳️ Requirements

• Active AHIMA or AAPC certification, 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-associated environment.

• Proficient experience across various medical specialties, including Emergency Department, Hospitalist, Primary Care, ENT, Nephrology, Urology, Cardiology, Thoracic, Neurology, Obstetrics and Gynecology, Behavioral Health, Ophthalmology, Endocrinology, and others.

• Advanced expertise and demonstrated auditing capabilities in ICD-10-CM diagnosis coding, CPT, HCPCS, modifiers, E/M leveling, and procedural coding.

• In-depth knowledge of professional coding standards, CPT guidelines and conventions, CMS regulatory requirements, NCCI edits, and other relevant professional coding and billing mandates.

• Capacity to independently investigate complex coding scenarios and interpret authoritative coding resources, including Official Coding Guidelines, Medicare/Medicaid Claims Processing Manual, OIG guidance, and LCD/NCD documents and transmittals.

• Skill in transforming audit findings and identified trends into clear, actionable educational material and delivering personalized feedback in a one-on-one coaching format.

• Experience in participating in or supporting peer review, audit-the-auditor initiatives, calibration, and other quality assurance processes.

• Proficient computer skills, including knowledge of EHR systems like EPIC and Cerner, automated auditing tools, and secure file transfer practices in line with HIPAA regulations.

• Exceptional verbal and written communication abilities.

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

• Capability to remain impartial and objective when finalizing and presenting audit results.

🏝️ Benefits

• Medical, Dental, Vision, and Life Insurance.

• Short/long-term disability coverage.

• Paid Time Off (PTO).

• 401(K) retirement plan.

• Referral bonuses.

• Opportunities for training.

• Annual educational allowances.

• Continuing education programs.

• A dedicated support team for guidance and mentoring.

• Recognition on birthdays.

• Holiday gift selections.

• Awards for years of service.

• Quality bonus programs.

• Opportunities for career growth and development.

• A dynamic work environment.