Quality Analyst – Outpatient, Healthcare

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate the work of coding auditors for accuracy and consistency.

• Confirm audit findings, supporting documentation, and rationales align with client and program expectations.

• Examine medical records to assess the accuracy of facility coding.

• Categorize root cause analyses and report recurring trends to the Quality Manager.

• Guide coding auditors and offer constructive feedback.

• Conduct quality assessments for initial audits and appeals.

• Oversee QA inventory while meeting quality, productivity, and turnaround standards.

• Detect overpayment and underpayment issues, aiding in audit reporting and trend analysis.

• Engage in calibration sessions to ensure consistent review decisions and the application of coding guidance.

• Suggest improvements to processes.

• Raise recurring errors, guideline inquiries, and process deficiencies to the Quality Manager.

• Stay informed about updates from CMS, payers, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifiers, and ICD-10-CM.

• Carry out other assigned responsibilities.

• Adhere to company compliance, information security, and regulatory policies.

⛳️ Requirements

• Bachelor’s Degree.

• CCS, CPC, or COC certification is mandatory.

• CPMA, COSC, CCC, or CASCC certification is preferred.

• A minimum of 5 years of coding experience.

• Experience in professional or hospital coding.

• Comprehensive knowledge of ICD-10-CM, HCPCS/CPT, OPPS, and APC.

• Capability to code complex outpatient services, including interventional radiology, ambulatory surgery, emergency room, and observation.

• Proficiency in Medicare LCDs and NCDs.

• Expertise in NCCI edits, MUEs, and facility modifiers such as 59/XS, 73/74, and 25.

• Ability to compose professional notes referencing recognized coding and Medicare resources.

• Prior experience in coding audits, compliance reviews, RAC, or payer-side Payment Integrity audits is preferred.

• Experience in reviewing operative reports for complex surgical procedures is preferred.

• Exceptional verbal, written, and interpersonal communication skills.

• Strong organizational abilities, attention to detail, and accuracy.

• Capacity to work independently as well as collaboratively in a team setting.

• Flexibility and adaptability.

• Advanced skills in coding audits and monitoring.

• Excellent decision-making capabilities and sound judgment.

• Strong technical knowledge and quick adaptability to new systems.

• Efficiency in completing tasks, resolving issues, and meeting deadlines.

• Proficient in Microsoft Excel, PowerPoint, Outlook, and Word.

🏝️ Benefits

• Dynamic, fast-paced, and innovative work environment.

• Opportunity to collaborate closely with seasoned healthcare consultants.

• Exposure to various aspects of clients’ businesses.

• Development of teamwork and time-management skills.

• Mentoring program with a senior-level professional advisor for junior employees.

• Opportunities for career advancement and professional development.