ProFee | Profession Fee QA Auditor  

• Perform coding quality audits of professional fee services, Surgical and E&M areas to assure appropriateness and accurate code assignments, modifiers and E&M levels in accordance with Center of Medicare and Medicaid guidelines.
• Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported.
• Audits codes and professional fee services performed by providers from medical records according to ICD-10, CPT, HCPCS, and CMS guidelines.
• Develops and coordinates education and training regarding the elements of coding such as appropriate documentation, accurate coding, coding trends found during chart reviews.
• Meets with the coders to review the audit findings and to recommend ways to improve when indicated.
• Prepares written reports of the audit findings by provider/practice.
• Responsible for maintaining up to date knowledge of coding guidelines as they relate to professional services.
• Performs other functions as assigned

• Professional Coding Experience in Multi-Specialty, Surgical, plus E&M.
• Working knowledge of CMS coding and documentation rules and regulations
• Able to identify and apply rules and regulations as they relate to professional service audits
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing
• Ability to analyze and identify opportunities in documentation improvement
• Excellent verbal and written communications skills required
• Maintain confidentiality of client and departmental information
• Knowledge of medical terminology
• Knowledge of CPT-4, ICD-10 and HCPCS coding
• Organized and detail-oriented, with proven ability to multi-task
Certifications (One of the following Required):
• CCS, CCS-P, CPC or COC