Professional Fee QA Analyst

Gebbs Healthcare Solutions Inc

13d•$27 - $27•Remote

About The Position

GeBBS Healthcare Solutions is seeking an experienced Professional Fee (ProFee) Inpatient & Outpatient Coding Auditor for a fully remote, part-time role in the United States. The position is scheduled for 20 hours per week, Monday through Friday, with no weekends, and pays $27.00 per hour. The auditor reviews hospital-based inpatient and outpatient professional fee coding, validates code and modifier assignments, identifies documentation and compliance risks, and prepares detailed audit findings. The role also provides feedback, coaching, and education to coding professionals and supports quality improvement, reimbursement integrity, and compliance with coding guidelines, regulations, and payer requirements.

Requirements

At least 3 years of professional fee coding experience in hospital-based inpatient and/or outpatient settings.
At least 2 years of coding auditing, quality assurance, compliance, or coding education experience.
Active CPC, CPMA, or equivalent AHIMA/AAPC certification.
Strong proficiency in ICD-10-CM, CPT, HCPCS Level II, and modifier assignment.
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.
Ability to identify coding discrepancies, compliance concerns, and quality improvement opportunities.
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.

Nice To Haves

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.

Responsibilities

Conduct comprehensive audits of professional fee inpatient and outpatient coding for 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, including 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 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 with findings, recommendations, and educational opportunities.
Provide constructive feedback, coaching, and coding education to improve coding accuracy and consistency.
Monitor coding quality trends, identify root causes of errors, and recommend corrective actions.
Collaborate with coding leadership and operational teams on 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.