Profee/HCC Coding Auditor - Audit project

GHR Travel Nursing; Baltimore (MD); Remote; USD 239,000 - 284,000; Full time

Benefits offered by this job

401K with Matching

Healthcare

Dental and Vision

Job summary

GHR Travel Nursing seeks a Remote Professional Fee Coding Auditor specializing in HCC risk adjustment, physician coding, and primary care documentation. The role focuses on retrospective medical record audits, identifying coding opportunities, and delivering actionable recommendations to support compliant reimbursement.

The engagement runs quarterly with 2-week initial duration, 8-hour days, and remote collaboration across Baltimore, MD, aiming for timely preliminary findings and consistent

Qualifications

• At least 3 years of Professional Fee coding experience including coding audit responsibilities.
• Strong experience with HCC coding, risk adjustment, physician coding, and medical record review.
• Proficiency auditing ICD-10-CM, CPT, and HCPCS coding.
• Knowledge of Medicare Advantage and Medicaid managed care risk adjustment methodologies.
• Experience reviewing primary care and chronic disease management encounters.
• Ability to identify unsupported diagnoses, missed HCC opportunities, documentation deficiencies, and coding discrepancies.
• Strong understanding of coding compliance, medical necessity, documentation standards, and payer requirements.
• Ability to work independently, maintain accuracy, and meet established audit deadlines and productivity expectations.
• Experience preparing structured audit reports and communicating findings to coding or healthcare leadership.
• Certification in CRC/CPC/CCS-P/CCS; CRC preferred.
• Strong spreadsheet and audit documentation skills.

Responsibilities

• Conduct quarterly retrospective Professional Fee coding audits across assigned provider encounters and payer classes
• Review medical records and validate ICD-10-CM diagnosis codes, CPT codes, HCPCS codes, HCC assignments, and risk adjustment accuracy
• Evaluate chronic condition documentation, diagnosis specificity, medical necessity, and coding compliance
• Identify missed HCC opportunities, unsupported diagnoses, documentation gaps, and recommended coding corrections
• Prepare detailed audit findings in a structured spreadsheet with supporting rationale for each recommendation
• Recommend improvements to diagnosis coding, procedure coding, risk adjustment assignments, and provider documentation practices
• Submit preliminary audit findings within the established review timeline
• Incorporate reviewer feedback following the designated review period
• Participate in remote exit conferences to discuss audit results and improvement opportunities
• Maintain consistent audit quality while meeting the expected productivity level of approximately five encounters per hour

Skills

HCC coding

Risk adjustment

Physician coding

Medical record review

ICD-10-CM auditing

CPT auditing

HCPCS auditing

Medicare Advantage knowledge

Medicaid knowledge

Audit reporting

Education

CRC/CPC/CCS-P/CCS certification

Job description

Remote Professional Fee Coding Auditor - HCC & Risk Adjustment

Remote Healthcare Coding Audit Project | Baltimore, Maryland Connection

Join a focused healthcare revenue integrity initiative as a Professional Fee Coding Auditor specializing in HCC risk adjustment, physician coding, and primary care documentation. This remote medical coding audit opportunity is ideal for an experienced coding professional who can conduct retrospective medical record audits, identify coding and documentation opportunities, and provide actionable recommendations that support accurate reimbursement, regulatory compliance, and improved clinical documentation.

This remote engagement supports healthcare operations connected to Baltimore, Maryland, a dynamic and accessible city known for its strong healthcare community, historic neighborhoods, and vibrant waterfront culture.

Remote Coding Audit Job Details

• Work Arrangement: Remote
• Engagement: Quarterly Professional Fee coding audit project
• Initial Duration: 2 weeks
• Schedule: 8-hour days, 5 shifts per week
• Weekly Estimated Pay: $5,250-$6,240
• Audit Volume: 30 encounters per coder per quarter, generally organized as 10 encounters per month
• Productivity Expectation: Approximately 5 encounters per hour
• Completion Timeline: Preliminary findings completed within 4 weeks of receiving assigned encounters

Professional Fee Coding Auditor Requirements

• At least 3 years of Professional Fee coding experience, including coding audit responsibilities
• Strong experience with HCC coding, risk adjustment, physician coding, and medical record review
• Proficiency auditing ICD-10-CM, CPT, and HCPCS coding
• Knowledge of Medicare Advantage and Medicaid managed care risk adjustment methodologies
• Experience reviewing primary care and chronic disease management encounters
• Ability to identify unsupported diagnoses, missed HCC opportunities, documentation deficiencies, and coding discrepancies
• Strong understanding of coding compliance, medical necessity, documentation standards, and payer requirements
• Ability to work independently, maintain accuracy, and meet established audit deadlines and productivity expectations
• Experience preparing structured audit reports and communicating findings to coding or healthcare leadership
• One of the following certifications: CRC, CPC, CCS-P, or CCS; CRC certification is strongly preferred
• Strong spreadsheet and audit documentation skills

HCC Risk Adjustment Audit Responsibilities

• Conduct quarterly retrospective Professional Fee coding audits across assigned provider encounters and payer classes
• Review medical records and validate ICD-10-CM diagnosis codes, CPT codes, HCPCS codes, HCC assignments, and risk adjustment accuracy
• Evaluate chronic condition documentation, diagnosis specificity, medical necessity, and coding compliance
• Identify missed HCC opportunities, unsupported diagnoses, documentation gaps, and recommended coding corrections
• Prepare detailed audit findings in a structured spreadsheet with supporting rationale for each recommendation
• Recommend improvements to diagnosis coding, procedure coding, risk adjustment assignments, and provider documentation practices
• Submit preliminary audit findings within the established review timeline
• Incorporate reviewer feedback following the designated review period
• Participate in remote exit conferences to discuss audit results and improvement opportunities
• Maintain consistent audit quality while meeting the expected productivity level of approximately five encounters per hour

Benefits

401K with Matching, Healthcare, Dental and Vision

Equal Opportunity

We are an equal opportunity employer and value diversity across our organization. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.