Pro Fee Quality Team Lead

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

Lead Duties (50%; approximately 20 hours/Week)

• The Lead will be responsible for assisting with the onboarding and training of pro fee reviewers to include but not be limited to resource tools, drives where facility guidelines are stored, One Note, Replicon, education portal, P&P’s, and client specific policies.
• The Lead will be responsible for creating client review training workflows and associated training materials as needed.
• The Lead will collaborate with coding operations leaders and oversee the pro fee QA pre-bill assignments
• Assist with reviewer connectivity process for new or existing clients and troubleshooting with the review team for resolution
• The lead will collaborate with onshore and offshore coding leadership to update the pro fee review assignment sheet and distribute to the review team weekly

QA Duties (50%; approximately 20 hours/Week)

• The Pro Fee quality reviewer will be responsible for reviewing the entire patient record documentation for the date of service being audited to validate the accuracy of code and abstract data elements.
• Validation of the applicable code elements.
• Ensure coding quality review number of accounts per coder (as noted on review assignment list) for each coder’s work is completed monthly.
• 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).
• Will run coder productivity reports (where applicable) from the facility system, GuideAudit production or pull random sample accounts from the completed coding spreadsheet for review.

What You Will Need:

• Must hold one of the following active credentials: (CPC, COC, CPMA RHIT, RHIA, CCS, CIC or COC).
• Must have a high school diploma/GED. Relevant experience accepted in lieu of a degree.
• Must maintain coding credentials while employed by Guidehouse.
• Must pass Guidehouse coding competency exam.
• Must have at least 8 years of pro fee coding or review experience.
• Abide by all client policies and procedures.
• Abide by all Guidehouse policies and procedures.
• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.

• Ability to work with Microsoft Office, Excel, and computer programs as well as company specific programs.

What Would Be Nice To Have:

• ·Auditing experience is preferred.
• Previous leadership experience.
• BS/BA is preferred

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 Opportunity Employer-Protected Veterans, Individuals with Disabilities 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 [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

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.