Professional Fee QA Analyst

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