Lead Facility Outpatient & Profee Internal Coding Auditor

e4health; Pittsburgh (Allegheny County); Remote; USD 90,000 - 120,000; Full time

Job summary

e4health is seeking a Lead Outpatient/PF Auditor for a fully remote role. You will perform quality assurance reviews on outpatient coding, including facility and professional fee coding, while training staff and delivering actionable educational insights.

The ideal candidate holds an AHIMA or AAPC credential, with 4+ years coding and full chart auditing experience, including remote work. Trauma experience is a plus; strong accuracy and productivity are essential.

Qualifications

• AHIMA or AAPC credential required.
• 4+ years coding experience.
• 4+ years full chart auditing experience.
• Experience in Outpatient Facility and Pro Fee coding.
• Level 1 Trauma experience.
• At least 2 years remote experience.
• Ability to shift between projects and meet productivity/quality expectations.
• Job Details: Full chart audits for facility Outpatient and Pro Fee.

Responsibilities

• Complete all regularly scheduled quality assurance reviews for clients.
• Complete onboarding QA reviews for newly hired consultants.
• May provide training for newly hired coding consultants.
• Communicate quality issues to management as appropriate.
• Assist with quality improvement action plans for coding consultants.
• Maintain reports and accuracy rates for coding consultants and clients.
• Respond to client QA needs at management direction.
• Provide coding consultants educational sessions on error trends.

Skills

Coding experience

Audit experience

Remote work experience

Trauma experience

Training auditors

Education

AHIMA or AAPC credential

Job description

Job Description

Description

About e4health

At e4health, our vision is to Empower Better Health for our clients, our team, and the communities we serve. We live by five core values that guide everything we do:

• Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth.
• Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day.
• WE GROW: We believe in win/win outcomes—when our customers win, we win.
• GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions.
• Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully.

Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our solutions streamline clinical, financial, and health information workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at www.e4.health.

POSITION TITLE

Lead Outpatient/PF Auditor

ROLE TYPE

Full Time

EMPLOYMENT TYPE

Non-Exempt

JOB SUMMARY

The Outpatient Auditor is responsible for completing quality assurance reviews on internal and/or external outpatient coding specialists or external providers. The facility-based chart types may include one or more of the following: Emergency Department, Observation, Same Day Surgery, Ancillary, Interventional Radiology, or Facility-Based Clinic. This may also include onboarding audits and training of newly hired e4health coding specialists. This role is responsible for validating the coding specialist is accurately for accurately abstracting data into appropriate client electronic medical record systems, following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, and CMS directives. The Outpatient Auditor also plays a key role in reporting quality results, tracking and trending of educational opportunities of the coding specialist, responding to client subject matter needs, and providing educational support and training to coders and/or providers. The Outpatient Auditor is expected to maintain consistent coding auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Complete all regularly scheduled quality assurance reviews for clients
• Complete onboarding quality assurance reviews for newly hired consultants
• May provide training for newly hired coding consultants
• Communicate quality issues to management as appropriate
• Assist with identification of, drafting, implementation, and monitoring of quality improvement action plans for coding consultants
• Maintain reports and accuracy rates for coding consultants and clients as appropriate.
• Respond to client QA needs at the direction of management
• Provide coding consultants educational sessions on error trends as requested by management
• Notifying management when there is a compliance concern or incident
• Demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information
• Promoting confidentiality and using discretion when handling patient information.
• Attend educational conference calls
• Provide coding support to the business as needed
• Perform other duties as needed with the project
• Maintains required productivity and quality requirements
• Maintains coding credential requirements

BENEFITS

We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long term disability insurance, and PTO policy.

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS

• This role requires prolonged periods of desk working on a computer
• Talking, hearing, and near vision are required to perform computer-based tasks and virtual communication
• Sensory perception (visual, auditory, and tactile) is essential for computer and phone use

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS

This is a remote role; work is performed in a home office environment.

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.

Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position

REQUIRED QUALIFICATIONS

• Candidate must possess an approved AHIMA or AAPC coding credential
• Minimum 4 years’ coding experience required
• Minimum 4 years of full chart auditing experience preferred
• Experience in both Outpatient Facility and Professional Fee coding and auditing
• Level 1 Trauma experience
• At least 2 years of remote experience
• Training auditors; Highly skilled outpatient & profee auditors with a minimum of 4 years auditing experience
• Ability to shift between projects, work autonomously, meet productivity and quality expectations
• Job Details: Full chart audits for everything facility Outpatient and Professional Fee related. Help with onboarding, ongoing, and/or focused reviews monthly. Plus administrative support for OP/PB audits.

KEY SUCCESS ATTRIBUTES

• Integrity, passion, and ethics are required
• Demonstrates strong collaboration skills
• Has strong analytic and problem-solving abilities and techniques
• Exhibit consistent initiative with strong drive for results and success
• Demonstrate commitment to a team environment?
• Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail
• Ability to self-motivate and self-direct
• Possess strong time management and organizational skills
• Commitment and adherence to company Core Values

CORE COMPETENCIES

• High level of integrity & ethical judgement
• Communication
• Consistency and Reliability
• Meeting Standards