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Job Title:
Coding Quality Analyst
Department:
Health System Shared Services | MIM CDI and Coding
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…