Remote Pro Fee Quality Reviewer
Posted on: November 23, 2022
Guidehouse is a leading global provider of consulting services to
the public sector and commercial markets, with broad capabilities
in management, technology, and risk consulting. By combining our
public and private sector expertise, we help clients address their
most complex challenges and navigate significant regulatory
pressures focusing on transformational change, business resiliency,
and technology-driven innovation. Across a range of advisory,
consulting, outsourcing, and digital services, we create scalable,
innovative solutions that help our clients outwit complexity and
position them for future growth and success. The company has more
than 12,000 professionals in over 50 locations globally. Guidehouse
is a Veritas Capital portfolio company, led by seasoned
professionals with proven and diverse expertise in traditional and
emerging technologies, markets, and agenda-setting issues driving
national and global economies. For more information, please visit
The Remote Pro Fee - Coding Quality Reviewer shall report directly
to the Quality Review Supervisor and will be responsible for
accessing and reviewing the medical record documentation, coding
and abstracting accuracy as performed by the Guidehouse coding team
by utilizing ICD-10 CM, CPT and HCPCS coding classification
systems. Review of patient records will be conducted via facility
EMR, scanning technology or other established method. This position
will perform any and all related job duties as assigned.
Duties and Responsibilities:
+ Ensure 5% coding quality review (or percentage stipulated in
client contract) of each coder's work is conducted monthly for
those facilities the reviewer is assigned. 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).
+ Reviewer will run coder productivity reports (where applicable)
to pull random sample accounts for review and to ensure review
percentages are met per facility contract.
+ Review coding and abstracting on all patient types assigned for
review to include the following: inpatient, ambulatory surgery, ER,
clinic, diagnostics and evaluation and management levels to assure
95% coder accuracy (or accuracy percentage as stipulated by client
+ Become familiar with any facility specific coding guidelines and
know where to access on the Navigant portal.
+ Required to read all Coding Clinic and CPT Assistant updates and
stay abreast of all new coding guidelines.
+ Ensure code recommendations are supported with AHA Coding
guidelines, Coding Clinics, CPT Assistant and/or other official
+ Perform chart reviews and coding recommendation notifications (to
ensure appropriate turnaround times) to coding team in a timely
manner (same day review conducted).
+ Enters review findings daily for each account reviewed in quality
review software or no less than within 24 hours of conducting the
+ Communicates in a professional, non-threatening mentorship manner
with the coding team in coding quality recommendation
+ Follows review escalation policy when coder/review disagreements
occur (see quality review policy/procedures).
+ Notify VP of Quality when coding risk areas and error trends are
identified for a specific facility and/or coder.
+ Assist Coders in answering coding/abstracting questions resulting
from the quality reviews.
+ Reviews monthly and quarterly coder quality reports and performs
intensification reviews for Coders who fall below the stipulated
accuracy rate as part of the corrective action plan.
+ Maintain a working knowledge of ICD-10-CM and CPT coding
principles, governmental regulations, official coding guidelines,
and third-party requirements regarding documentation and
+ Ability to maintain average review productivity standards as
+ Emergency Department (without E/M): 7 charts per hour
+ Emergency Department with E/M: 4 charts per hour
+ Diagnostics: 12-15 charts per hour
+ Surgeries (any service line): 3-4 charts per hour
+ Pro Fee Evaluation/Management Level (any setting or service line
without procedure): 5 charts per hour
+ Pro Fee Evaluation/Management Level (any setting or service line
with procedure (major procedure): 3 per hour
+ Claim Edit Review: 10-15 per hour
+ Complete review activity summary daily (productivity summary) for
each facility and submit to QC Supervisor and Director on a weekly
basis (utilized to calculate quality review FTEs assigned to each
+ Review and be familiar with the annual review criteria standards
as well as DRG review calendar (if appropriate to assignment).
+ Assist as needed in the review of external coding audit company
findings and formulates a response to be used in the defense of the
+ Participates in client conference calls and mandatory monthly
quality team stand-up calls. Responsible to review the minutes of
monthly quality stand up calls if not able to dial into the
conference call (minutes are posted on the portal).
+ Provide company support for the creation, maintenance and ongoing
operation of an efficient and accurate Quality Improvement Plan
that is compliant with Local, State, and Federal Government
+ Work with the Coding Solutions Division to provide on-going
coding education resulting from the Quality Reviews. This will
involve direct one-on-one correspondence between the coder and
+ Maintain open lines of communication serving as a liaison between
client, Coders, and Coding Solutions Division to ensure that all
parties are kept up to date on specific hospital
+ Participate in company Coding Solutions Division Meetings as
+ Reviewer must be able to work independently while maintaining
specific productivity standards.
+ Basic computer skills are needed to handle connection issues,
downloads and to review specific programs.
+ Reviewer downtime must be reported immediately to the IQC
Supervisor and Director to ensure adequate work flow.
+ Access to the facility system or any other system that prohibits
you from completing your work assignment should be reported
immediately to the IQC Supervisor and Director and Guidehouse
support help desk (via phone and/or email notification with a copy
to the QC Supervisor/Director)
+ Reviewers must maintain their current professional credentials
while working for Guidehouse.
+ Reviewers are responsible for maintaining HIPAA compliant work
stations (reference HIPAA work station policy).
+ Reviewers are responsible for maintaining patient privacy at all
times (reference company handbook policy).
+ Reviewers are responsible for signing a confidentiality
+ It is the responsibility of each reviewer to review and adhere to
the coding division policy and procedure manual content.
+ Works well with other members of the facilities coding and
billing team to insure maximum efficiency and reimbursement for
properly documented services.
+ Communication in emails should be professional and collaborative
at all times (reference e-mail policy).
+ Must hold one of the following credentials: (CPC, CPMA,
+ Three years of previous coding / review experience.
+ Must have experience with: multispecialty E&M Coding and
Auditing, Multispecialty Surgery Coding and Auditing with an
emphasis in Orthopedics and General Surgery
+ 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
Information System Requirements:
+ Computer and monitors provided by Guidehouse.
+ Internet Access with DSL or high-speed connectivity.
+ Remote office location that meets HIPAA privacy requirements.
+ The successful candidate must not be subject to employment
restrictions from a former employer (such as a non-compete) that
would prevent the candidate from performing the job
responsibilities as described.
The salary range for this role is $38.00 - $40.00 , may vary based
on experience and location.
Guidehouse is an Equal Employment Opportunity / Affirmative Action
employer. All qualified applicants will receive consideration for
employment without regard to race, color, national origin,
ancestry, citizenship status, military status, protected veteran
status, religion, creed, physical or mental disability, medical
condition, marital status, sex, sexual orientation, gender, gender
identity or expression, age, genetic information, 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
RecruitingAccommodation@guidehouse.com . All information you
provide will be kept confidential and will be used only to the
extent required to provide needed reasonable accommodation.
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.
Rewards and Benefits
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
+ Medical, Rx, Dental & Vision Insurance
+ Personal and Family Sick Time & Company Paid Holidays
+ Position may be eligible for a discretionary variable incentive
+ Parental Leave and Adoption Assistance
+ 401(k) Retirement Plan
+ Basic Life & Supplemental Life
+ Health Savings Account, Dental/Vision & Dependent Care Flexible
+ Short-Term & Long-Term Disability
+ Tuition Reimbursement, Personal Development & Learning
+ Skills Development & Certifications
+ Employee Referral Program
+ Corporate Sponsored Events & Community Outreach
+ Emergency Back-Up Childcare Program
Keywords: Guidehouse, Hartford , Remote Pro Fee Quality Reviewer, Other , Hartford, Connecticut
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