Guidehouse Quality Review Supervisor - Remote in Albany, New York
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 www.guidehouse.com.
The Quality Review Supervisor shall report directly to the Internal Quality Control Director. This position will be responsible for managing the day to day operations of the physician professional fee BPM quality review team, reviewing and approving timesheets, monthly tracking and reporting of reviewer productivity, monitoring project utilization, ensure pre-bill reviews are assigned, performed and reported timely; and timely update of the review assignment. Must have strong knowledge of physician professional fee coding to include surgical multi-specialty CPT coding. The Lead Quality Reviewer will assist Coding Managers when requested in resolving coder and reviewer disagreements. Will assist in providing coder and reviewer education for coding issues or trends identified, and as new federal or state coding guidelines are published. This position will perform any and all related job duties as assigned. This position is 100% remote.
• Maintain a working knowledge of ICD-10-CM and CPT coding regulations and principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and coding for professional fee and surgical coding.• Ensure reviewers meet physician BPM quality review productivity standards:
• 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 • 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* Excludes outliers*
• Manage review team daily work assignments, ensure timely completion and if a reviewer is behind or out, ensure coverage and assistance.• Responsible for training new BPM pro fee coders (training to include but not be limited to: resource tools, drives where facility guidelines are stored, One Note, PeopleSoft, education portal, P&P’s, and client specific policies)• Develop review process workflow for each client, assist review team in identification of charts for review (running coder productivity report or request charts) and ensure daily data entry into NavAudit.• Create NavAudit facility template for new pro fee coding or audit clients.• Report physician pro fee BPM reviewer productivity monthly utilizing review productivity spreadsheet matrix. Productivity will be reported by the 10th working day of each month (for prior month)• Responsible to review monthly PeopleSoft utilization report for pro fee BPM reviewers, if any employee below 90% utilization will research, provide rationale and take appropriate action to improve.• Run pro fee facility accuracy dashboard in NavAudit mid-month and end of month to ensure all reviews completed and ensure communication of coders below 95% accuracy to leads/managers/and QA leadership.• Responsible to oversee communication when BPM pro fee coders complete and pass prebill to leads/managers/QA leadership.• Responsible to keep BPM pro fee review assignment list updated and communicate updates timely as coder changes are communicated and sent out to the review team, leads and mangers • Responsible to review and approve pro fee reviewer timesheets prior to deadline• Responsible to monitor time off and vacation for pro fee reviewers to ensure appropriate coverage and staffing for completion of review assignments.• Responsible for timely completion of Executive and drill down (coder quality and encounter review details) reports for pro fee audits for external clients. • Interface with clients in a manner that is professional, well-prepared and ability to communicate clearly and efficiently to drive results.• Assist review team with research when requested to determine accurate code assignment. • Assist when requested in coder/reviewer disagreements that are escalated per the Outpatient Quality Review policy. • Work with the coding solutions team to provide on-going coding education resulting from the quality reviews as requested.• Maintain open lines of communication serving as a liaison between client, coders, reviewers, educators and Coding Solutions management team to ensure quality, and efficiency while delivering results.• Assist with agenda and quality review education for mandatory monthly quality review team meetings.• Participate in all coding operations meetings for BPM pro fee clients.• Reviewer downtime must be reported immediately to the IQC Director/VP to ensure adequate work flow.• Facility access system problems should be reported to administrative HIM team, facility IT and Navigant help desk immediately.• Any system issues should be reported to immediately to the IT help desk and Director notified. • Responsible for checking emails, and responding when required, at the beginning and end of each shift, and at least every 2 hours during the work day. Communication in emails should be professional and collaborative at all times (reference e-mail policy).• Responsible for maintaining HIPAA compliant work stations (reference HIPAA work station policy).• Responsible for maintaining patient privacy and adhering to Navigant’s privacy and PHI policies always (reference company handbook policy compliance section).
• Communicates and maintains the performance expectations of clients.• Anticipates customer needs and initiates action to meet and/or exceed those needs.• Identifies and recommends ways to improve client satisfaction.
• Must hold one of the following credentials: CPC, COC, CCS, CCS-P, CIC, RHIT, RHIA, or CPMA.• Must have prior management experience• Current coding professional fee coding experience required, minimum 5 years• Strong knowledge of Evaluation/Management coding and guidelines
• Strong coding skill set in multi-specialty CPT surgical code assignment to include: Neurosurgery, Cardio-thoracic, ENT, Orthopedics, Hematology/Oncology injections and infusions, Plastics, and OB/GYN.
• Abide by all client policies and procedures.• Abide by all Navigant policies and procedures.• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.
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.
Candidates from Eastern Standard Time, Central Standard Time, and Pacific Standard Time Zones as well as candidates from Arizona, New Mexico and Utah will be considered for this position.
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 workplace.
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 and Adoption Assistance
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
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