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.

• Independently investigate intricate coding scenarios and substantiate audit results with coding guidelines and regulatory references.

• Convert audit results and trends into concise, actionable educational materials.

• 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.

• Relay audit results, coding rationale, educational insights, and constructive feedback to coders, auditors, and leadership.

• Handle multiple assignments and deadlines while upholding quality and productivity standards.

⛳️ Requirements

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

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

• Proficient in various medical specialties, including but not limited to Emergency Department, Hospitalist, Primary Care, ENT, Nephrology, Urology, Cardiology, Thoracic, Neurology, Obstetrics and Gynecology, Behavioral Health, Ophthalmology, and Endocrinology.

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

• Comprehensive knowledge of professional coding guidelines, CPT conventions, CMS regulatory requirements, NCCI edits, and other pertinent professional fee coding and billing regulations.

• Capability to independently examine 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.

• Proficiency in translating audit findings and recognized trends into clear, actionable educational content while providing tailored feedback and one-on-one coaching.

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

• Strong computer skills, including familiarity with EHR systems such as EPIC and Cerner, automated auditing tools, and secure file transfer compliant with HIPAA policies.

• Exceptional verbal and written communication abilities.

• Strong organizational and time-management skills; capacity to prioritize competing responsibilities, meet deadlines, and maintain quality and productivity standards.

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

🏝️ Benefits

• Medical, Dental, Vision, and Life Insurance.

• Short and long-term disability coverage.

• Paid Time Off (PTO).

• 401(K) retirement 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.

• Awards for years of service.

• Quality bonus programs.

• Opportunities for career growth and development.

• A dynamic work environment.