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.

• Utilize and refine skills related to professional fee auditing and coding.

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

• Convert audit results and trends into clear, actionable educational content.

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

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

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

• Handle multiple assignments and deadlines in a fast-paced, quality-focused environment.

• Conclude and present unbiased, objective audit results.

• Telecommute while adjusting to shifting priorities.

⛳️ Requirements

• Valid 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-affiliated context.

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

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

• Strong comprehension of professional coding guidelines, CPT guidelines and conventions, CMS regulatory requirements, NCCI edits, and other relevant profee coding and billing mandates.

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

• Ability to convert audit results and identified trends into clear, actionable educational content and provide tailored feedback and one-on-one coaching.

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

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

• Exceptional verbal and written communication abilities.

• Robust organizational and time-management skills; capability to prioritize competing tasks, meet deadlines, and uphold quality and productivity standards.

• Ability to remain neutral 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.