Profee ED Auditor/QA Specialist
About The Position
GeBBS Healthcare Solutions is seeking an experienced Professional Fee (ProFee) Emergency Department Coding Auditor / QA Specialist to join our remote team. This position is responsible for conducting comprehensive audits of professional Emergency Department coding, with a strong emphasis on ED Evaluation & Management (E/M) leveling, procedure coding, documentation accuracy, and regulatory compliance. The ideal candidate will have a proven background in ProFee ED auditing, exceptional attention to detail, and the ability to identify coding discrepancies, provide actionable feedback, and support ongoing quality improvement initiatives.
Requirements
- Minimum of 3 years of professional coding auditing experience, specifically involving ProFee Emergency Department services.
- Active CEMC and/or CPC certification required.
- Demonstrated expertise in Professional Fee ED E/M leveling and procedure coding — both are required.
- Strong understanding of Emergency Department documentation, medical necessity, modifier usage, and appropriate code assignment.
- Comprehensive knowledge of ICD-10-CM, CPT, HCPCS, and applicable coding and billing regulations.
- Knowledge of E/M documentation guidelines and current coding requirements.
- Experience conducting detailed coding audits, identifying discrepancies, and providing constructive feedback.
- Ability to independently complete manual or technology-assisted coding audits.
- Excellent analytical, organizational, written, and verbal communication skills.
- Proficiency with Microsoft Office applications, including Excel and Word.
- Ability to manage multiple priorities, maintain accuracy, and consistently meet productivity expectations.
- Must reside in the United States and be available to work Monday through Friday.
Nice To Haves
- CPMA certification.
- Additional AHIMA credentials such as CCS-P, RHIA, or RHIT.
- Experience with Revenue Integrity and Charge Capture.
- Experience providing coder or physician education and communicating audit findings to stakeholders.
- Familiarity with client-specific onboarding reviews, quality assurance processes, and performance reporting.
Responsibilities
- Perform detailed audits of Professional Fee Emergency Department encounters, ensuring accurate E/M leveling, procedure coding, and appropriate code assignment.
- Conduct onboarding coding reviews and quality assessments to support client-specific requirements and standards.
- Review medical documentation for compliance with ICD-10-CM, CPT, HCPCS, and applicable payer guidelines.
- Identify coding discrepancies, documentation deficiencies, missed charges, and opportunities for improved accuracy and compliance.
- Apply current and historical E/M documentation guidelines, including 1995, 1997, and updated 2021 and subsequent guidelines, as applicable to the services being audited.
- Prepare accurate audit reports, summarize findings, and provide recommendations for corrective action.
- Collaborate with coding teams, leadership, and clients to communicate audit findings and support quality improvement initiatives.
- Assist with coder and provider education, including clarification of coding guidelines, documentation requirements, and audit findings.
- Maintain established quality and productivity standards while meeting client deadlines.
- Stay current with regulatory updates, coding changes, and Medicare, Medicaid, and commercial payer requirements.
Benefits
- Collaborative remote environment
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
