Job
Description
Job Summary: The Medical Coding Quality Analyst Manager is responsible for overseeing the quality and accuracy of medical coding operations. This role ensures compliance with industry standards, payer policies, and regulatory requirements, while also leading quality assurance initiatives, training programs, and process improvements to enhance coding accuracy and efficiency. Key Responsibilities: Quality Assurance & Compliance: Oversee and manage the coding quality review process to ensure compliance with ICD-10-CM, ICD-10 PCS, CPT, HCPCS, and HCC risk adjustment guidelines. Develop and implement auditing processes to monitor coder accuracy and adherence to regulatory and payer requirements. Conduct and oversee internal and external audits to assess coding accuracy and identify areas for improvement. Develop corrective action plans for coders who do not meet accuracy benchmarks. Maintain and analyze coding quality reports, identifying trends and areas requiring training. Training & Development: Provide feedback and coaching to improve coder performance. Collaborate with the Education and Training teams to enhance ongoing learning opportunities. Leadership & Team Management: Supervise a team of quality analysts, auditors, and medical coders. Conduct performance evaluations and provide professional development opportunities. Foster a culture of continuous improvement and compliance. Process Improvement & Documentation: Identify inefficiencies and implement strategies to enhance coding workflow and quality. Maintain detailed documentation of coding audits, quality control measures, and compliance reports. Work cross-functionally with HIM, Compliance, and Revenue Cycle teams to optimize coding accuracy. Stakeholder Collaboration: Serve as a key point of contact for providers, payers, and regulatory agencies on coding-related issues. Assist in the development of policies and procedures to ensure coding integrity. Communicate audit findings and best practices to leadership and stakeholders. Experience: 8+ years of experience in medical coding and auditing. 2+ years of experience in a leadership or managerial role. Strong knowledge of HCC, Risk Adjustment, DRG, CPT, HCPCS, and ICD-10 coding guidelines. Experience with EMR/EHR systems, coding software, and claims processing .
