Coding Quality Analyst

Job Description

After medical records are coded in Medical Information Management (MIM), the Coding Quality Analyst is responsible for ensuring accuracy of coding assignment via random auditing of medical record coding and accuracy of MS-DRGS. In addition, the manager is responsible for completing 3M APC Software claim edits and responding to requests from the Central Business Office (CBO) regarding documentation required for compliance with CMS National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE) edits. The analyst is responsible for providing feedback to the Manager of Data Quality regarding coding quality and makes recommendations for improving coding accuracy.

Position Summary
The position is primarily responsible for coding quality improvement. This staff member reviews randomly selected and focused medical records for accurate selection of appropriate admitting and discharge diagnoses, ICD9-CM procedures and CPT4 procedures. The analyst uses the encoding and abstracting system and other resources to ensure complete and accurate coding, DRG/MS-DRG assignment for hospital reimbursement, research and planning. The analyst keeps detailed records of all audits conducted, the results, recommendations, and follows-up to assure action is taken. The analyst advises medical record coding specialist on coding guidelines and practices as requested.

Minimum Qualifications

Associate degree in Health Information Management, and a minimum of 3-5 years medical center outpatient coding experience (ICD10-CM and CPT) for service types such as emergency, outpatient, ambulatory surgery, observation, and series/clinics. Bachelor's degree in Health Information Administration or equivalent degree preferred. Considerable progressively responsible administrative medical information management experience required knowledge and experience with electronic health records and health information management applications required. Certifications can include: Registered Health Information Record Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS) by the American Health Information Management Association, COC (outpatient credential only).