Pro Fee Quality Team Lead

US104 Guidehouse Managed Services LLC; McLean (VA); Hybrid; USD 74,000 - 124,000; Full time

Benefits offered by this job

Medical, Dental & Vision Insurance

401(k) Retirement Plan

Life Insurance

Job summary

Guidehouse is seeking a Lead Pro Fee Reviewer to assist with onboarding, training, and workflow development for pro fee review teams. The role includes QA oversight, policy adherence, and cross-functional collaboration with onshore/offshore leaders.

The position requires CPC/COC/CPMA/RHIT/RHIA/CCS/CIC credentials, a high school diploma, and at least 8 years of pro fee coding or review experience. On-site in McLean, VA with comprehensive benefits.

Qualifications

• Must hold one of the following active credentials: CPC, COC, CPMA, RHIT, RHIA, CCS, CIC or COC.
• Must have a high school diploma/GED.
• Relevant experience accepted in lieu of a degree.
• Must pass coding competency exam and maintain credentials.

Responsibilities

• Lead duties: onboarding and training of pro fee reviewers; create training workflows and materials; oversee QA pre-bill assignments.
• QA duties: review full patient records for coding accuracy; run productivity reports; identify coding errors.
• Collaborate with coding leadership on assignment distribution and process improvements.

Skills

Microsoft Office

Excel

Education

CPC

COC

CPMA

RHIT

RHIA

CCS

CIC

High school diploma

Tools

GuideAudit

OneNote

Replicon

Job description

Job Family: General Coding Travel Required: None Clearance Required: None

What You Will Do:

Lead Duties (50%; approximately 20 hours/Week)

The Lead will be responsible for assisting with the onboarding and training of pro fee reviewers to include but not be limited to resource tools, drives where facility guidelines are stored, One Note, Replicon, education portal, P&P’s, and client specific policies. The Lead will be responsible for creating client review training workflows and associated training materials as needed. The Lead will collaborate with coding operations leaders and oversee the pro fee QA pre-bill assignments Assist with reviewer connectivity process for new or existing clients and troubleshooting with the review team for resolution The lead will collaborate with onshore and offshore coding leadership to update the pro fee review assignment sheet and distribute to the review team weekly

QA Duties (50%; approximately 20 hours/Week)

The Pro Fee quality reviewer will be responsible for reviewing the entire patient record documentation for the date of service being audited to validate the accuracy of code and abstract data elements. Validation of the applicable code elements. Ensure coding quality review number of accounts per coder (as noted on review assignment list) for each coder’s work is completed monthly. Coding quality review will be conducted to identify abstracting, ICD-10-CM, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team (see quality review policies for review details). Will run coder productivity reports (where applicable) from the facility system, GuideAudit production or pull random sample accounts from the completed coding spreadsheet for review.

What You Will Need:

• Must hold one of the following active credentials: (CPC, COC, CPMA RHIT, RHIA, CCS, CIC or COC).
• Must have a high school diploma/GED.
• Relevant experience accepted in lieu of a degree.
• Must maintain coding credentials while employed by Guidehouse.
• Must pass Guidehouse coding competency exam.
• Must have at least 8 years of pro fee coding or review experience.
• Abide by all client policies and procedures.
• Abide by all Guidehouse policies and procedures.
• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.
• Ability to work with Microsoft Office, Excel, and computer programs as well as company specific programs.

What Would Be Nice To Have:

• Auditing experience is preferred. Previous leadership experience. BS/BA is preferred #LI-DNI

The annual salary range for this position is $74,000.00-$124,000.00.

Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance Personal and Family Sick Time & Company Paid Holidays Position may be eligible for a discretionary variable incentive bonus Parental Leave 401(k) Retirement Plan Basic Life & Supplemental Life Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts Short-Term & Long-Term Disability Tuition Reimbursement, Personal Development & Learning Opportunities Skills Development & Certifications Employee Referral Program Corporate Sponsored Events & Community Outreach Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [e-mail].

All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [e-mail]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.

Guidehouse is a global AI-led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future.

guidehouse.com