Remote Professional Fee Coding Auditor

About the job Remote Professional Fee Coding Auditor

Remote Professional Fee Coding Auditor

VISN 7 Health Information Management Services - Remote United States

This Position Is Contingent Upon Contract Award

Work Location

Department of Veterans Affairs

Veterans Integrated Service Network 7

Health Information Management Services

Remote within the United States

Supporting VISN 7 medical facilities

Fully remote coding and auditing services

Citizenship / Access Requirements: U.S. citizenship and English-language proficiency are required for VA system access. Personnel must satisfy all VA onboarding, identity-verification, training, and access requirements applicable to the position.

Security Requirements: No classified clearance is specified. The position is designated Low Risk and requires a favorable National Agency Check with Inquiries background investigation, annual VA privacy and security training, and all applicable system-access approvals.

Number of FTEs: Not specified. Staffing must be sufficient to meet assigned workload, quality, accuracy, and turnaround requirements.

Type of Employment: Full-Time or Part-Time, based on assigned workload.

Estimated Total Compensation: $38.00 per hour.

Working Hours: No fixed individual shift is specified. Remote schedules are assignment-dependent and must support required turnaround times and coverage aligned with Charleston VA Medical Center business hours.

Work Arrangement: Fully remote within the United States. All work must be physically performed in the United States using approved equipment, software, encoder tools, internet connectivity, reference resources, and a secure workspace.

Period of Performance: January 1, 2027 through December 31, 2031, if all four option periods are exercised.

Summary of Services

The Professional Fee Coding Auditor will independently review inpatient and outpatient professional-fee coding for VISN 7. The auditor will assess documentation sufficiency, diagnosis and procedure coding, modifiers, bundling, compliance, and financial impact; report findings; recommend improvements; and provide facility-specific education.

Mandatory Qualifications

Must be a U.S. citizen and be able to read, write, speak, and understand English.

Must satisfy the coder education and credential requirements, including an active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.

Must have at least two years of coding experience in the applicable coding area.

Must have at least three years of consultant experience reviewing records in large tertiary-care hospitals and outpatient organizations with primary care and subspecialty services.

Must have at least three years of education and training experience and be able to present audit findings and facility-specific coding education.

Must be proficient with applicable ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, DRG, modifier, bundling, reimbursement, documentation, and compliance requirements.

Must successfully complete the Low Risk NACI background process and all required VA privacy, information-security, and mandatory training.

Must be able to work securely within the United States, maintain audit accuracy of at least 95 percent, and meet all reporting and turnaround requirements.

Duties and Responsibilities

Independently audit inpatient and outpatient professional-fee coding for accuracy, documentation support, compliance, and reimbursement impact.

Evaluate ICD-10-CM, CPT, HCPCS Level II, evaluation and management, modifier, professional-component, and bundling assignments.

Verify provider information, scope of practice, billability, and documentation support for reported professional services.

Identify incorrect, missing, unbundled, upcoded, downcoded, unsupported, or otherwise noncompliant codes and modifiers.

Review relevant diagnoses and procedures in the electronic health record and approved audit tools using established sampling requirements.

Document each finding with clear supporting authority, financial impact, risk, and recommended corrective action.

Maintain audit accuracy of at least 95 percent and participate in calibration processes that support inter-reviewer consistency.

Contribute to audit work plans, collection tools, facility reports, consolidated reports, and required progress updates.

Review preliminary findings with HIMS leadership, the COR, management, and designated facility personnel.

Prepare or support final reports addressing accuracy, documentation issues, financial impact, process imp