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United States
Remote only
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Professional Fee Coding Auditor based in the United States.
This fully remote role supports coding quality and compliance across medical facilities within a large regional healthcare network.
You will independently audit professional-fee coding for documentation accuracy, regulatory compliance, and reimbursement impact.
The position focuses on provider services, diagnoses, procedures, evaluation and management coding, modifiers, and professional components.
You will identify discrepancies, document findings, assess financial and compliance risks, and recommend corrective actions.
The role also includes preparing reports, participating in calibration activities, and delivering facility-specific coding education.
You will collaborate with health information management leadership and facility stakeholders while maintaining strict confidentiality.
The assignment requires a high level of coding expertise, attention to detail, and consistent audit accuracy in a regulated environment.
Independently audit inpatient and outpatient professional-fee coding for accuracy, documentation support, compliance, and reimbursement impact.
Evaluate ICD-10-CM, CPT, HCPCS Level II, evaluation and management, professional-component, modifier, and bundling assignments.
Verify provider information, scope of practice, billability, and documentation supporting reported professional services.
Review diagnoses and procedures documented in electronic health records and approved audit tools according to established sampling requirements.
Identify incorrect, missing, unbundled, upcoded, downcoded, unsupported, or otherwise noncompliant codes and modifiers.
Document each audit finding with appropriate supporting authority, financial impact, risk assessment, and recommended corrective action.
Maintain a minimum audit accuracy of 95% and participate in calibration activities to promote consistency among reviewers.
Contribute to audit work plans, data collection tools, facility reports, consolidated reporting, and required progress updates.
Review preliminary findings with health information management leadership, the Contracting Officer's Representative, management, and designated facility personnel.
Prepare or support final reports covering coding accuracy, documentation deficiencies, financial impact, process improvement opportunities, and educational needs.
Develop and deliver facility-specific coding education and support exit conferences when required.
Protect sensitive healthcare information and follow all privacy, information-security, encryption, and remote-work requirements.
Maintain required credentials and complete all assigned audits, reports, training, and access requirements within established deadlines.
Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential from an accepted professional organization.
At least two years of professional coding experience in the applicable coding area.
At least three years of consultant experience reviewing records in large tertiary-care hospitals and outpatient organizations serving primary care and subspecialty populations.
At least three years of education and training experience, including the ability to present audit findings and deliver facility-specific coding education.
Strong knowledge of ICD-10-CM, CPT, HCPCS Level II, evaluation and management services, modifiers, professional components, bundling, reimbursement, documentation, and coding compliance requirements.
Demonstrated ability to evaluate provider documentation and determine whether reported professional services and codes are adequately supported.
Strong analytical and critical-thinking skills, with the ability to identify coding errors and clearly explain their compliance, financial, and operational implications.
Ability to maintain at least 95% audit accuracy while meeting reporting and turnaround requirements.
Excellent written, verbal, presentation, and interpersonal communication skills.
Strong attention to detail, organization, documentation, and quality control.
Ability to work independently while collaborating effectively with health information management leadership and facility stakeholders.
U.S. citizenship and English-language proficiency required for system access.
Ability to successfully complete a Low Risk NACI background investigation and all required privacy, information-security, and mandatory training.
Ability to work securely from an approved location within the United States and protect sensitive healthcare information.
Candidates must provide a current resume, signed Letter of Intent, completed candidate cover page, proof of active credentials, and two current client references specific to the individual reviewer.
Compensation: Estimated total compensation of $38.00 per hour.
Work arrangement: Fully remote within the United States.
Employment options: Full-time or part-time, depending on assigned workload.
Contract period: Expected performance period from January 1, 2027 through December 31, 2031, if all option periods are exercised.
Professional impact: Opportunity to improve coding accuracy, documentation quality, compliance, reimbursement integrity, and education across multiple healthcare facilities.
Specialized experience: Exposure to professional-fee coding audits, compliance review, financial-impact analysis, reporting, and facility-level education.
Flexible remote environment: Work is performed remotely using approved equipment, systems, coding tools, reference resources, and a secure workspace.
Structured support: Work within established audit methodologies, quality standards, coding guidance, privacy requirements, and healthcare information management processes.
