Professional Fee Auditor

This is a Full Remote job, available from anywhere.

Role Summary: Responsible for reviewing professional fee (ProFee) physician coding to validate accuracy, compliance, and documentation support. This role identifies risks, ensures coding consistency, and provides clear feedback to improve overall coding quality.

Core Responsibilities:

• Perform retrospective and/or concurrent audits of professional fee coding.
• Validate CPT, HCPCS, ICD-10-CM code selection, and modifier usage.
• Follow and adhere to AHIMA’s Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
• Identify trends, risks, and opportunities for coding improvement.
• Provide clear, actionable audit feedback and education to coding staff.
• Maintain established quality metrics (e.g., ≥95% coding accuracy) and meet productivity standards.

Minimum Qualifications:

• Credentials: CPC, CPMA, CCS, RHIA, or RHIT (active).
• Experience: Minimum 3+ years professional fee auditing experience and at least 2 years of auditing experience. In lieu of auditing experience, 7+ years of coding experience is required. Prior coding experience strongly preferred. Experience auditing physician services (hospital-based or large practice physician services preferred).
• Skills & Knowledge: Strong knowledge of RVU and CPT/HCPCS, ICD-10-CM, modifiers, and NCCI edits. Strong written communication skills and high attention to detail.