Coding Quality Analyst
Core
Evaluating the accuracy, completeness, and compliance of outpatient medical coding through audits of coded medical records and automated coding systems.
Role type
Outpatient Coding Quality Analyst
Builds
Accurate hospital reimbursement, research, and planning data
Domain
Healthcare / Medical Coding
Required skills
Outpatient coding (ICD-10-CM, CPT), Automated coding systems, NCCI/OCE edits, Audit analysis, Regulatory compliance, Documentation review
Preferred skills
Coding education and training, Quality improvement initiatives, Trend analysis
Technologies
Electronic Health Records (EHR), Craneware, IHIS, Spreadsheets, Automated reporting tools
Responsibilities
Conduct random, focused, and risk-based audits of outpatient medical records; Resolve claim and coding edits using NCCI, OCE, and payer guidance; Document audit findings and trends; Provide feedback and guidance to coding specialists; Collaborate with leadership to address compliance risks and improve coding practices.
Seniority
Mid-level, hands-on IC
