CDQA Administrative Analyst

Role overview

Coding quality and audit support

• Maintain enterprise-wide and department coding policies and procedures and monitor compliance with external regulatory coding rules.
• Coordinate internal and external coding audits; track and summarize results across PHS.
• Coordinate and track training for coding, audit, physician, and clinician personnel and corrective action plans for low performers.
• Review medical records and billing for denied and appealed claims with coder and clinical auditor assistance.
• Compile coding scorecard metrics for denials, appeals, and coding accuracy; correct patient accounts based on audit findings.

Compliance, analysis, and liaison work

• Research regulatory requirements and coding updates, including ICD, CPT, HCPCS, and APC changes; recommend or implement corrective action plans for compliance issues.
• Liaise with information services, finance, patient financial services, hospitals, clinics, compliance, and ancillary departments on coding, audit, and training issues.
• Respond to coding and audit inquiries and management requests; investigate customer concerns involving patient care or billing.
• Analyze audit data, communicate results to management, maintain accurate documentation, and record inquiry resolutions in information systems.

Qualifications

• High school diploma or GED required.
• One year of healthcare clinical, coding, auditing, compliance, or patient financial services experience.
• Medical terminology, ICD-9/10, CPT-4, and HCPCS knowledge required.
• Excellent written and verbal communication; detail- and results-oriented; able to work independently.

Benefits

• Benefits-eligible employees receive medical, dental, vision, short- and long-term disability, group term life insurance, and other optional benefits.
• Employee Wellness rewards program offers opportunities to participate in wellness activities.

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