Pro Fee Quality Reviewer - Remote

at Guidehouse in Dover, Delaware, United States

Job Description

Job Family :

General Coding

Travel Required :


Clearance Required :


What You Will Do :

The Remote Pro Fee Coding Quality Reviewer shall report directly to the Pro Fee Quality Review Supervisor and will be responsible for accessing and reviewing the medical record documentation, coding and abstracting accuracy as performed by the Guidehouse coding team by utilizing ICD-10 CM, CPT and HCPCS coding classification systems. Review of patient records will be conducted via facility EMR, scanning technology or other established method. This position will perform any and all related job duties as assigned. This position is 100% remote.

Duties and Responsibilities

+ Ensure coding quality review percentage or number of accounts per coder as stipulated on the review assignment list of each coder’s work is conducted monthly for those facilities the reviewer is assigned. Coding quality review will be conducted to identify abstracting, ICD-10-CM, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team (see quality review policies for review details).

+ Review coding and abstracting on all patient types assigned for review to include the following: inpatient, ambulatory surgery, ER, clinic, diagnostics and evaluation and management levels to assure 95% coder accuracy (or accuracy percentage as stipulated by client contract).

+ Ensure code recommendations are supported with AHA Coding guidelines, Coding Clinics, CPT Assistant and/or other official coding references.

+ Perform chart reviews and coding recommendation notifications (to ensure appropriate turnaround times) to coding team in a timely manner (same day review conducted).

+ Assist Coders in answering coding/abstracting questions resulting from the quality reviews.

+ Ability to maintain average review productivity standards as follows:

+ Emergency Department (without E/M): 7 charts per hour

+ Emergency Department with E/M: 4 charts per hour

+ Diagnostics: 12-15 charts per hour

+ Surgeries (any service line): 3-4 charts per

+ Pro Fee Evaluation/Management Level (any setting or service line without procedure): 5 charts per hour

+ Pro Fee Evaluation/Management Level (any setting or service line with procedure (major procedure): 3 per hour

+ Claim Edit Review: 10-15 per hour

What You Will Need :

+ Must hold one of the following active credentials: (CCS, CPC, CIC, COC, RHIA, RHIT).

+ 1-3 years of Pro Fee Surgery Review or Audit experience

+ Must have three years of coding or review experience.

+ Must maintain coding credential while employed by Guidehouse.

Information System Requirements:

+ Computer and monitors provided by Guidehouse.

+ Internet Access with DSL or high-speed connectivity.

+ Remote office location that meets HIPAA privacy requirements.

What Would Be Nice To Have :

+ 1+ years of pro fee subspecialty auditing such as EM and Anesthesia.


The annual salary range for this position is $50,600.00-$91,100.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer :

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

+ Medical, Rx, Dental & Vision Insurance

+ Personal and Family Sick Time & Company Paid Holidays

+ Position may be eligible for a discretionary variable incentive bonus

+ Parental Leave

+ 401(k) Retirement Plan

+ Basic Life & Supplemental Life

+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

+ Short-Term & Long-Term Disability

+ Tuition Reimbursement, Personal Development & Learning Opportunities

+ Skills Development & Certifications

+ Employee Referral Program

+ Corporate Sponsored Events & Community Outreach

+ Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

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Job Posting: JC241293941

Posted On: Jun 02, 2023

Updated On: Jan 07, 2024

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