Quality Analyst, Medical Coding (Inpatient, Outpatient, Denials)

Job Purpose

The Quality Analyst, Medical Coding , collaborates with internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. The Quality Analyst, Medical Coding  will assess and review the overall quality of coding on accounts completed by Medical Coders. The Quality Analyst, Medical Coding , ensures adherence to workflows and ethical coding. The position requires advanced knowledge of professional coding (CPT, ICD-10-CM and HCPCS). The incumbent is responsible for designing and implementing quality coding review programs and communicating review findings and recommendations to coding management. The position obtains statistics and the information necessary to assess risk for all areas of coding.

Duties and Responsibilities

• Sets team direction, resolves problems and provides guidance to members of own team
• Lead, coach, recognize and develop a team of Employees in all aspects of the job to meet objectives and maintain company culture, polices, goals and procedures
• Administer the Quality Assessment process to ensure all quality standards/targets can be met
• Daily management of all operational processes to ensure that quality, efficiency and productivity standards/targets are met
• Acts as client contact for day-to-day operational issues and staff assignments. Escalate any client concerns immediately to Medical Coding Manager or General Manager.
• Review and analyze reports, records, and data to meet and exceed client and company objectives.
• Collaborate with all workgroups to resolve issues that impact internal and external customers.
• Rewarding and disciplining employees; addressing complaints and resolving problems
• Look constantly for development as well as continuous improvement for the entire team.
• Ensure that the employees follow their schedules properly as designed.
• Strive for new ways to increase the opportunities of efficient, accurate work assignments.
• Handle complaints, questions, and queries as necessary.
• Documenting general reports on each team member’s performance and targets as well as ensuring that they exceed the targets.
• Monitor systems to ensure optimal performance.
• Disseminates changes in guidelines and rules; monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement to assure compliance.
• Foster an environment of teamwork and service excellence within the department.
• Participate in performance improvement activities.
• Assist in the establishment of, implementation and maintenance of a formalized review process to ensure compliance with contractual agreements regarding accuracy rates.
• Assist in the creation, monitoring and standardization of company policies and procedures to monitor the success of the data quality management plan, review our and our clients areas of risk, investigate identified issues, report data analyses and take appropriate steps to correct any violations. Make recommendations to ensure the highest compliance rate with the Med-Metrix quality management plan.
• Participate in conference calls/meetings with management and staff to ensure all performance and training recommendations are addressed and improvement suggestions are implemented.
• Assist in new hire training classes, transition periods and refresher trainings as needed
• Knowledge of, understanding of, and compliance with all Med-Metrix policies and procedures.
• Provide feedback to management concerning possible problems or areas of needed improvement.
• Use, protect and disclose patients’ Protected Health Information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

• Graduate of any Medical or Allied Medical course or has equivalent work experience.
• Hold AAPC and/or AHIMA certification. CPMA is an advantage.
• Proficient with E/M and CPT Procedure coding.
• Minimum of six months of experience with exceptional performance in the chosen area of quality management
• Medical Coding – demonstrated HIPAA knowledge required
• Ability to work in a team fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures and unexpected workloads and stresses.
• Possess strong verbal, written communication, interpersonal skills and analytical skills
• Willingness and flexibility to work extended hours.
• Assertive self-starter who can work independently, yet function in a team environment
• Ability to plan well and prioritize work and maintain calmness under pressure.
• An understanding and strict adherence to all HIPAA regulations

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.