HIM QA Coding Analyst

$56,742 - $85,114/Yr

Unclassified - Saint Joseph, MO

Full-time - Mid Level

Saint Joseph, MO

About the position

Mosaic Life Care is seeking a HIM QA Coding Analyst to join our Health Information Management team. This full-time position is crucial in ensuring compliance with legal, accreditation, and internal standards through comprehensive audits and assessments. The HIM QA Coding Analyst will perform both random and targeted audits to identify high-risk areas within the organization, including professional, facility, clinic, external vendor, coder, system, and denial audits. This role requires collaboration with other HIM Managers to create, review, and update departmental processes, guidelines, and standards in accordance with regulatory changes and organizational compliance laws and regulations. The HIM QA Coding Analyst will also be responsible for developing and providing education for clinical staff, providers, and coders, ensuring that all parties are well-informed about coding and documentation standards. Exceptional communication skills, both verbal and written, are essential as this position serves as a liaison with various departments, including Knowledge Management, Health Information Management, Patient Financial Services, Revenue Integrity, and clinical staff. The analyst will utilize strong problem-solving and research skills to interpret CMS regulations and guidance, assisting leadership in identifying and monitoring process improvements to maintain compliance with organizational policies and regulations. In addition to auditing and compliance responsibilities, the HIM QA Coding Analyst will analyze existing policies, identify gaps, and recommend new or revised standards and monitoring methods. They will design and implement risk assessments to analyze coding and documentation processes, prioritizing these assessments based on the level of organizational exposure. The role also involves investigating and responding to audits identified by various regulatory contractors, ensuring that potential issues are addressed proactively before they escalate. This position works under the guidance of the HIM Data Quality Manager and is integral to maintaining the integrity and quality of health information management within Mosaic Health System.

Responsibilities

• Perform random and targeted audits to identify high-risk areas for the organization.
• Collaborate with HIM Managers to create, review, and update departmental processes and guidelines.
• Develop and provide education for clinical staff, providers, and coders.
• Serve as a liaison with various departments including Knowledge Management and Patient Financial Services.
• Analyze existing policies, identify gaps, and recommend new or revised standards.
• Design and implement risk assessments to analyze coding and documentation processes.
• Investigate and respond to audits identified by regulatory contractors.
• Facilitate the resolution of noncompliant findings and escalate critical issues to QA Manager.
• Audit documentation, billing, coding, medical necessity, systems, and reimbursement processes.
• Analyze results of assessments for presentation to clinic leadership and compliance.

Requirements

• Associates degree in a healthcare-related discipline preferred.
• CPC, CCS, COC, RHIT, or RHIA certification required.
• Minimum of 5 years coding/billing experience in the healthcare industry preferred.
• Experience performing coding audits or working with providers to correct coding issues is a plus.

Nice-to-haves

• Experience as a coder, consultant, and/or auditor in the healthcare industry.
• Demonstrated success in correcting coding and documentation issues.

Benefits

• Free parking
• Concierge services
• Employee lounge
• Wellness programs
• Free on-site and virtual health clinics