Remote Pro Fee Coding Quality Reviewer

📋 Description

• • Serve as the final gatekeeper of coding excellence for Guidehouse’s Federal coding team, performing 100 % remote quality reviews of professional-fee (Pro Fee) encounters that also include facility coding in a single, one-touch workflow.
• • Dive deep into electronic medical records, scanned charts, and any client-designated data source to validate ICD-10-CM, CPT, and HCPCS code selection, sequencing, and abstraction accuracy—protecting the integrity of every claim before it reaches federal payers.
• • Deliver clear, actionable feedback to coders and supervisors, documenting trends, root-cause errors, and education opportunities that directly improve team performance and reduce denial rates.
• • Maintain an unwavering 95 %+ individual quality score while meeting daily review quotas that keep client backlogs at zero—even during surge periods or new-client onboarding.
• • Partner with Compliance, Audit, and Client Delivery teams to interpret evolving federal regulations, local coverage determinations, and payer policy updates, ensuring every reviewed encounter remains audit-proof.
• • Champion continuous improvement by piloting new QA workflows, testing encoder upgrades, and refining review checklists that later become the gold standard across Guidehouse’s national coding portfolio.
• • Uphold the highest standards of data security and HIPAA compliance; every click, note, and report you create is subject to federal background-check clearance and client confidentiality agreements.
• • Contribute to monthly scorecards and executive dashboards that influence staffing decisions, coder education priorities, and client contract renewals valued in the tens of millions of dollars.
• • Mentor junior reviewers through virtual huddles, lunch-and-learns, and one-on-one coaching sessions—growing the next generation of coding quality leaders without leaving your home office.
• • Embrace a culture of curiosity: attend quarterly skills labs, earn advanced certifications on company time, and share battlefield stories that turn complex coding scenarios into teachable moments for the entire team.