Professional Fee Auditor (ProFee)

Description

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.

Requirements

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 preferred 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.

Client & Specialty Alignments

• Surgical Specialties: Requires deep understanding of the CPT surgery section, advanced modifier and NCCI validation, and experience auditing operative documentation.
• Medical & E/M-Based Specialties: Requires expertise in E/M leveling, documentation review, and the ability to assess medical necessity and coding accuracy.
• Diagnostic & Ancillary Specialties: Requires knowledge of professional component coding, modifier use, and experience auditing high-volume, rules-based workflows.

Work Model & Employment Tracks

• Work Model: 100% remote, independent, quality-focused work environment with collaboration across coding, audit, and client teams.
• Full-Time (FT): Standard production aligned to client or project needs.
• Part-Time / PRN / Project-Based: Flexible support for backlog, specialty coverage, or targeted initiatives.
• Note: Some positions may require evening or weekend coverage based on client needs or project scope.

Why Sage Clinical RCM

• National exposure to diverse, high-acuity health systems and specialties.
• Quality-first culture with realistic expectations (not volume-only).
• Flexible work options (FT, PT, and PRN).
• Opportunity to expand into other audit, education, and advisory services.