Professional Fee QA Analyst

GeBBS; United States; A distancia; USD 31.000 - 44.000; A tiempo parcial

Descripción de la vacante

GeBBS Healthcare Solutions is seeking an experienced Professional Fee Inpatient & Outpatient Coding Auditor for a remote, part-time role (20 hours/week, Monday-Friday).

You will audit professional fee coding across inpatient and outpatient services, ensure accuracy and compliance with ICD-10-CM, CPT, HCPCS, and modifiers, and provide actionable feedback to coding staff. The position emphasizes CMS/NCCI guidance and ongoing education.

Formación

• Minimum 3 years of professional fee coding experience in hospital inpatient/outpatient settings.
• Minimum 2 years of coding auditing, quality assurance, compliance, or coding education experience.
• Active CPC, CPMA, or AHIMA/AAPC equivalent certification required.
• Strong proficiency in ICD-10-CM, CPT, HCPCS Level II, and modifier assignment.
• Experience with Official Coding Guidelines, Coding Clinic guidance, NCCI/OCE edits, and payer policies.
• Proven ability to identify coding discrepancies, compliance concerns, and quality improvement opportunities.

Responsabilidades

• Conduct comprehensive audits of professional fee inpatient and outpatient coding for accuracy and compliance.
• Review medical records to validate ICD-10-CM, CPT, HCPCS Level II, and modifier assignments including Hospital E/M leveling and office procedures.
• Identify coding errors, documentation gaps, and opportunities for improvement.
• Evaluate modifier usage, code sequencing, and alignment with guidelines.
• Prepare audit reports with findings, recommendations, and education opportunities.
• Provide feedback, coaching, and coding education to improve accuracy and consistency.
• Monitor coding quality trends and root causes, recommending corrective actions.
• Collaborate with coding leadership and operations to support QA and process improvements.
• Research coding updates, reimbursement regulations, and payer guidelines to stay compliant.

Conocimientos

Professional fee coding

Auditing

Regulatory compliance

Attention to detail

Communication

Independent work

Time management

Educación

CPC/CPMA or AHIMA/AAPC certification

Herramientas

EHR systems

Encoder software

Auditing platforms

Revenue cycle applications

Epic

Descripción del empleo

GeBBS Healthcare Solutions is a leading provider of Revenue Cycle Management (RCM) and Risk Adjustment services, helping healthcare organizations optimize operations, improve financial performance, maintain compliance, and enhance the patient experience. Recognized as a KLAS® Top Performer, GeBBS combines innovative technology, industry expertise, and a commitment to excellence to deliver measurable results for clients across the healthcare industry. We are dedicated to being a trusted healthcare partner by upholding the highest standards of quality, information security, and compliance.

At GeBBS, we foster a collaborative and growth-oriented culture where employees are empowered to develop their skills, advance their careers, and make a meaningful impact in transforming healthcare.

GeBBS Healthcare Solutions is seeking an experienced Professional Fee (ProFee) Inpatient & Outpatient Coding Auditor to join our team in a remote, part-time capacity, Monday-Friday

The ideal candidate brings a strong background in professional fee coding and auditing across hospital-based inpatient and outpatient services, with expertise in ICD-10-CM, CPT, HCPCS, and modifier assignment to include Hospital E/M leveling, Bedside procedures, Office E/M leveling and in-office procedures.

In this role, you will conduct coding audits, identify compliance risks, evaluate documentation accuracy, and provide meaningful feedback and education to coding professionals. Your expertise will help ensure coding accuracy, regulatory compliance, reimbursement integrity, and continuous quality improvement.

Key Responsibilities

• Conduct comprehensive audits of professional fee inpatient and outpatient coding to ensure accuracy, completeness, and compliance with coding guidelines and payer requirements.
• Review medical records and validate ICD-10-CM, CPT, HCPCS Level II, and modifier assignments to include Hospital E/M leveling, Bedside procedures, Office E/M leveling and in-office procedures..
• Identify coding errors, documentation gaps, compliance risks, and opportunities for improvement.
• Evaluate appropriate modifier usage, code selection, and sequencing in accordance with applicable guidelines.
• Ensure compliance with CMS regulations, Official Coding Guidelines, Coding Clinic guidance, NCCI edits, OCE edits, and payer-specific policies.
• Prepare clear, detailed audit reports outlining findings, recommendations, and educational opportunities.
• Provide constructive feedback, coaching, and coding education to improve accuracy and consistency.
• Monitor coding quality trends, identify root causes of errors, and recommend corrective actions.
• Collaborate with coding leadership and operational teams to support quality assurance and process improvement initiatives.
• Research coding updates, reimbursement regulations, and payer guidelines to maintain compliance with industry standards.
• Meet established productivity, quality, and turnaround time expectations.

Required Qualifications

• Minimum 3 years of professional fee coding experience within hospital-based inpatient and/or outpatient settings.
• Minimum 2 years of coding auditing, quality assurance, compliance, or coding education experience.
• Active CPC, CPMA, or equivalent AHIMA/AAPC certification required.
• Strong proficiency in ICD-10-CM, CPT, HCPCS Level II, and modifier assignment.
• Demonstrated knowledge of professional fee coding guidelines, Medicare, Medicaid, commercial payer requirements, and reimbursement methodologies.
• Experience applying Official Coding Guidelines, Coding Clinic guidance, NCCI edits, OCE edits, and payer-specific policies.
• Proven ability to identify coding discrepancies, compliance concerns, and opportunities for quality improvement.
• Experience providing audit feedback, coding education, or coaching to coding professionals.
• Proficiency with EHR systems, encoder software, auditing platforms, and revenue cycle applications.
• Strong analytical, research, documentation, and communication skills.
• Ability to work independently, manage competing priorities, and consistently meet deadlines.

Preferred Skills & Experience

• Experience auditing both inpatient and outpatient professional fee services.
• Strong knowledge of hospital-based physician billing and coding practices.
• Experience developing educational materials or supporting coding quality improvement initiatives.
• Familiarity with computer-assisted coding (CAC) tools and coding audit reporting systems.
• Proficiency in Microsoft Excel, Word, and reporting tools.
• Ability to communicate audit findings effectively to coding professionals, management, and client stakeholders.
• Epic experience.

Position Details

Location: 100% Remote – United States

Schedule: Part-Time, 20 Hours per Week, Monday - Friday (no weekends)

Compensation: $27.00 per Hour

Position: ProFee Inpatient & Outpatient Coding Auditor

Why Join GeBBS?

At GeBBS Healthcare Solutions, you'll have the opportunity to apply your coding expertise, support quality improvement, and contribute to the success of healthcare organizations nationwide—all while working remotely.

If you're a detail-oriented coding professional with a passion for accuracy, compliance, and education, we'd love to hear from you!