Professional Fee QA Analyst

GeBBS Healthcare Solutions, Inc.; United States; Remote; USD 31.000 - 44.000; Teilzeit

Benefits dieser Stelle

Remote work

Zusammenfassung

GeBBS Healthcare Solutions is seeking an experienced Professional Fee (ProFee) Inpatient & Outpatient Coding Auditor to join the team in a remote, part-time capacity. The role focuses on auditing hospital-based professional fee coding, ensuring accuracy, compliance, and education for coding professionals.

You will review ICD-10-CM, CPT, HCPCS, and modifiers, prepare audit reports, and support quality improvement initiatives while meeting productivity targets.

Qualifikationen

• Minimum 3 years of professional fee coding in hospital-based settings.
• Minimum 2 years in auditing, QA, compliance, or coding education.
• Active CPC/CPMA or AHIMA/AAPC certification required.
• Strong proficiency in ICD-10-CM, CPT, HCPCS Level II, and modifiers.
• Knowledge of payer requirements, reimbursement methods, and guidelines.
• Experience applying Coding Clinic, NCCI, OCE, and payer policies.
• Ability to identify discrepancies and quality improvements.
• Experience providing audit feedback or coaching to staff.
• Proficiency with EHRs, encoders, auditing platforms, and RCM tools.
• Strong analytical, research, documentation, and communication skills.
• Ability to work independently and meet deadlines.

Aufgaben

• Conduct comprehensive audits of professional fee inpatient/outpatient coding for accuracy and compliance.
• Review records and validate ICD-10-CM, CPT, HCPCS Level II, and modifiers including E/M levels.
• Identify errors, risks, and opportunities for improvement.
• Evaluate modifier usage and code sequencing per guidelines.
• Ensure CMS, ICD guidelines, NCCI/OCE edits, and payer policies compliance.
• Prepare detailed audit reports with findings and recommendations.
• Provide audit feedback, coaching, and coding education.
• Monitor quality trends and root causes; propose corrective actions.
• Collaborate with leadership and operations on QA initiatives.
• Research coding updates and payer guidelines to stay compliant.
• Meet productivity, quality, and turnaround targets.

Kenntnisse

Professional fee coding

Auditing & QA

Regulatory knowledge

Communication skills

Independent work

Ausbildung

CPC/CPMA certification (AHIMA/AAPC)

Tools

EHR systems

Encoder software

Auditing platforms

CAC tools

Microsoft Excel

Reporting tools

Epic

Jobbeschreibung

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.

Location: 100% Remote – United States

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 remote.

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

The pay range for this role is:

27 - 27 USD per hour (Remote (United States))