Professional, Quality Analysis (Surgery)

Position Summary

The Coding Quality Analyst is responsible for assessing the accuracy, completeness, and compliance of medical coding practices across the organization. This role focuses on ensuring alignment between clinical documentation and coded data, supporting regulatory compliance, audit readiness, and revenue integrity. The analyst serves as a subject matter expert, providing education, feedback, and guidance to coding staff and providers to improve documentation quality and coding accuracy.

Key Responsibilities

• •Conduct retrospective and prospective audits of coded records to evaluate accuracy, consistency, and compliance with applicable coding guidelines (e.g., ICD-10-CM, CPT, E/M guidelines, and payer-specific requirements)
• •Identify documentation and coding gaps, trends, and opportunities for improvement across service lines, with a focus on high-risk areas such as E/M, ED, and specialty coding
• •Provide clear, actionable feedback to coders and providers, including detailed audit results and education on best practices
• •Develop and deliver coding and documentation education based on audit findings, regulatory updates, and organizational priorities
• •Collaborate with CDI, revenue cycle, compliance, and clinical leadership to ensure accurate capture of clinical complexity and appropriate reimbursement
• •Support internal and external audit activities, including payer audits, regulatory reviews, and compliance initiatives
• •Track and report key performance metrics, including coding accuracy rates, error trends, and audit outcomes
• •Assist in the development and maintenance of coding policies, procedures, and training materials
• •Serve as a subject matter expert for coding-related inquiries, providing guidance on complex cases and documentation scenarios
• •Stay current on regulatory changes, coding updates, and industry best practices, and ensure timely dissemination of relevant information

Qualifications

• •Active coding credential required (e.g., CPC, CCS, RHIT, RHIA)
• •Minimum of 6 years of professional coding experience, with demonstrated expertise in auditing and quality review
• •Strong knowledge of E/M coding guidelines, including 2021+ MDM-based coding
• •Experience with ED, outpatient, or specialty coding preferred
• •Familiarity with payer policies, CMS guidelines, and audit methodologies
• •Proficiency with electronic health record (EHR) systems and coding/audit tools

Skills & Competencies

• •Strong analytical and critical thinking skills with the ability to interpret complex clinical documentation
• •Excellent written and verbal communication skills, with the ability to provide constructive, provider-facing education
• •Detail-oriented with a high level of accuracy and accountability
• •Ability to identify trends, patterns, and root causes in coding and documentation issues
• •Strong organizational and time management skills, with the ability to prioritize multiple audit and education initiatives
• •Ability to work collaboratively across departments and with clinical stakeholders
• •Comfortable presenting education to providers and leadership audiences

Preferred Experience

• •Experience in coding quality auditing or CDI
• •Experience supporting provider education or documentation improvement initiatives
• •Background in high-volume environments such as Emergency Department or hospital-based services
• •Experience with audit tools, dashboards, or data analytics related to coding performance

Key Performance Indicators

• •Coding accuracy and quality scores
• •Reduction in audit findings and denials
• •Improvement in documentation completeness and specificity
• •Provider and coder engagement in education initiatives
• •Timeliness and effectiveness of audit feedback and reporting

Why This Role Matters

The Coding Quality Analyst plays a critical role in ensuring that the care delivered is accurately reflected in the medical record and appropriately translated into coded data. This position directly supports compliance, revenue integrity, and audit readiness while driving meaningful improvements in documentation and coding practices across the organization.