Coding Quality Analyst

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Job Title:

Department:

Scope of Position

The Outpatient Coding Quality Analyst is responsible for evaluating the accuracy, completeness, and compliance of outpatient coding within Medical Information Management (MIM) through random, focused, and risk-based audits of coded medical records, including records processed through automated coding systems.

The analyst reviews and resolves claim and coding edits and responds to Central Business Office (CBO) requests regarding coding and supporting documentation, including requirements associated with the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE) edits.

The analyst identifies coding discrepancies, documentation concerns, and trends that may contribute to denials or compliance risks.

Responsibilities include documenting audit findings, providing timely and actionable feedback, collaborating with coding leadership and education staff to address identified opportunities, and conducting follow-up reviews to evaluate the effectiveness of corrective actions.

The analyst maintains knowledge of current coding guidelines and applicable regulatory and payer requirements and provides recommendations to the Manager of Outpatient Coding Quality to strengthen coding accuracy, promote consistent coding practices, and support ongoing quality improvement and compliance.

Position Summary

Position eligible for remote work schedule.

The Outpatient Coding Quality Analyst supports coding quality improvement, regulatory compliance, and claim and coding edit resolution. The analyst conducts random, focused, and risk-based reviews of outpatient medical records, including records processed through automated coding systems, to evaluate the accuracy, completeness, and appropriateness of ICD-10-CM diagnosis and CPT/HCPCS procedure code assignment.

The analyst uses encoding and abstracting systems, the electronic health record, and approved coding resources to validate code assignment and support accurate hospital reimbursement, research, and planning. Audit activities, findings, and trends are documented and reported using designated systems, spreadsheets, and automated reporting tools. The analyst identifies opportunities for improvement and conducts follow-up reviews to assess the effectiveness of education and corrective actions.

The analyst resolves claim and coding edits using approved reference materials, including the National Correct Coding Initiative (NCCI), Outpatient Code Editor (OCE), Craneware, applicable payer guidance, and charge description master updates provided by the OSUWMC revenue cycle management team. The analyst follows established standard operating procedures when updating IHIS accounts and modifying codes or charges, ensuring changes are supported by documentation and accurately recorded.

The analyst provides coding specialists with timely feedback and guidance on coding guidelines and compliant practices. In collaboration with coding leadership and education staff, the analyst communicates audit findings, identifies educational needs, and recommends improvements to promote consistent coding practices and reduce coding-related denials and compliance risks.

Minimum Qualifications 

For Hire:        

• Minimum completion of a CAHIIM-approved coding certificate program or HIMT program.

• Demonstrated coding proficiency through satisfactory completion of OSUWMC’s coding test.

• Familiarity or experience with computer-assisted coding and/or automated encoder.

• Minimum preferred 2-4 years of outpatient coding experience (ICD10-CM and CPT) for service types such as emergency, outpatient, ambulatory surgery, observation, and series/clinics.

Required:

• Bachelors degree or equivalent experience. 2 years of relevant experience required. 2-4 years of relevant experience preferred.

• Required for hospital coding: Credentialed as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) by the American Health Information Management Association; Certified Outpatient Coder (COC), or CPC.

Competency expectations:

• Maintain continuing education requirements as determined by the American Health Information Management Association or American Academy of Professional Coders. Review Coding Clinics, CPT assistant as frequently as needed for education purposes, and to ensure the official coding guidelines are followed. 

• The medical records coding specialist attends coding meetings and coding education sessions for updates on coding guidelines and related education opportunities.

Certification

• RHIA, RHIT, CCS, COC, CPC

Additional Information:

Location:

Position Type:

Scheduled Hours:

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Final candidates are subject to successful completion of a background check.  A drug screen or physical may be required during the post offer process.

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