Pro Fee Quality Team Lead

Guidehouse; Washington (District of Columbia); On-site; USD 74,000 - 124,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Paid Holidays

Job summary

Guidehouse is seeking a Lead Pro Fee Coding/QA Lead in the Washington, DC area to guide onboarding, training, and QA activities for pro fee reviewers. You will partner with coding operations leaders, develop training workflows, and oversee QA pre-bill tasks, while ensuring accuracy across ICD-10-CM, CPT, and HCPCS coding.

This role requires eight years of pro fee coding or review experience and active credentials such as CPC, COC, CPMA, RHIT, RHIA, CCS, or CIC.

Qualifications

• Must hold active coding credentials (CPC, COC, CPMA, RHIT, RHIA, CCS or CIC).
• High school diploma or GED required; degree not mandatory.
• Maintain coding credentials during employment and pass competency exam.
• At least 8 years of pro fee coding or review experience.

Responsibilities

• Lead onboarding and training of pro fee reviewers.
• Create training workflows and materials as needed.
• Collaborate with coding operations leaders and oversee QA pre-bill assignments.
• Assist reviewer connectivity and troubleshoot with the team.
• Update assignment sheet with onshore/offshore leadership and distribute weekly.
• Review patient records to validate coding accuracy and abstract data.
• Run productivity reports and sample reviews.

Skills

CPC

COC

CPMA

RHIT

RHIA

CCS

CIC

Education

High school diploma or GED

Tools

Microsoft Office

Excel

Company-specific programs

Job description

Job Family:General CodingTravel Required:NoneClearance Required:NoneWhat 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 assignmentsAssist with reviewer connectivity process for new or existing clients and troubleshooting with the review team for resolutionThe lead will collaborate with onshore and offshore coding leadership to update the pro fee review assignment sheet and distribute to the review team weeklyQA 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-DNIThe 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 InsurancePersonal and Family Sick Time & Company Paid HolidaysPosition may be eligible for a discretionary variable incentive bonusParental Leave401(k) Retirement PlanBasic Life & Supplemental LifeHealth Savings Account, Dental/Vision & Dependent Care Flexible Spending AccountsShort-Term & Long-Term DisabilityTuition Reimbursement, Personal Development & Learning OpportunitiesSkills Development & CertificationsEmployee Referral ProgramCorporate Sponsored Events & Community OutreachEmergency Back-Up Childcare ProgramAbout GuidehouseGuidehouse 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. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [e-mail]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.