Coding Quality Assurance Analyst

The Coding Quality Assurance Analyst is responsible for performing weekly QA audits of all coding staff in the Valencia Regional Billing Office.
REQUIREMENTS
ESSENTIAL DUTIES AND RESPONSIBILITIESPerform weekly Coding Quality Assurance audits for all Valencia coding staff in accordance with USHW Coding Policies & ProceduresDocument audit results and maintain logs/tracking tools timelyProvide feedback to individual Coder and Coding Management personnel regarding audit resultsCompile monthly audit results / summaries for ManagementMonitor monthly statistical reports to identify trends and/or potential coding training issuesAssist in the development and distribution of internal training materials related to coding and/or reimbursementConduct group training sessions for Coders and/or other RBO staff, as neededMaintain inventory of all Coding and Documentation training materials and sign-in sheetsPrepare CEU certificates for training program participantsIdentify, communicate and track provider documentation issues/trendsAssist RBO staff with the analysis of claim and/or appeal/denial issues, as neededOther duties as assigned.
EDUCATION & EXPERIENCEHigh School diploma or equivalency. College degree preferred.Minimum of five years coding and/or physician reimbursement experience.
CA Workers’ Compensation industry knowledge preferred.Working knowledge of ICD-9, CPT and HCPCS coding nomenclature; fee schedule reimbursement methodology; and regulatory requirements for physician coding and reimbursement.
Working knowledge of key coding concepts such as use of CPT modifiers; surgical package definitions, medical record documentation requirements; and multiple procedure guidelines.Prior coding / documentation training preferred.Prior coding compliance auditing experience preferredComputer skills for practical purposes. Working knowledge of Word, Excel and PowerPoint required.
Ability to analyze statistical data preferredProficiency in internet search functionality is required.Prior formal training or a working understanding of basic Medical Terminology as well as Anatomy and Physiology.General understanding of professional fee billing processes and/procedures
LICENSE/CERTIFICATIONCPC Coding Certification is required