Clinical Quality Analyst
About the role
About Our Client:The organization operates globally in the healthcare sector, focusing on improving health outcomes through the integration of care, pharmacy benefits, data, and resources. It addresses challenges related to access and equity in health services by connecting individuals to necessary care and support, aiming to advance health equity at scale.
About the Opportunity:The Clinical Quality Analyst role is responsible for serving as a key liaison between coding teams and healthcare providers to ensure accurate documentation and coding compliance. This position supports clinical leadership and collaborates across teams to improve coding quality, provide targeted education, and conduct audits that enhance revenue integrity and compliance. The role plays a critical part in maintaining coding standards, supporting provider education, and addressing coding-related challenges.
Responsibilities
- Act as liaison between coding teams and providers to resolve inquiries
- Collaborate with Edits and Denials teams on trend analysis and corrective actions
- Support clinical leadership during new service implementations to ensure coding accuracy
- Participate in specialty and physician group meetings to provide coding education
- Deliver coding and documentation training to new providers
- Provide annual updates on code set changes to providers
- Conduct annual audits validating charges and documentation, identifying revenue opportunities
- Provide targeted education and follow-up audits for providers not meeting quality standards
- Perform ad hoc audits based on client requests or concerns
- Educate coders and providers on audit findings and trends
- Assist with rebuttals for tri-annual audits as needed
Qualifications
- High School Diploma or GED
- Professional coder certification (AHIMA and/or AAPC credentials) maintained annually
- Minimum 3 years of physician medical coding experience in a multi-specialty clinic
- At least 2 years experience in a residency program with surgical coding and multiple specialties
Skills
- Proven ability to provide expert coding guidance to physicians, practitioners, and coders
- Intermediate knowledge of MUE and NCCI classification and reimbursement
- Intermediate proficiency with Windows PC, MS Excel, and Epic system
Pay
Hourly pay ranges from $29.00 to $52.00 based on experience and qualifications.