Senior Coding Quality Analyst – Special Investigations Unit

Job Description: • Perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices • Conduct comprehensive quality reviews of completed medical coding reviews to ensure coding logic aligns with medical record documentation • Analyze data, documentation, and evidence to identify potential billing errors, abuse, or fraudulent activity • Handle complex coding reviews related to legal, compliance, escalations, audits, and rework initiatives • Prepare detailed written summaries of findings and clearly articulate conclusions to leadership • Independently research and apply state, CMS, and payer specific guidelines relevant to audits and reviews • Identify opportunities for process improvements, cost savings, and cases that may warrant prepayment review • Maintain accurate documentation, records, files, and tracking logs while meeting established deadlines and performance metrics • Regularly use departmental tools and workflows with minimal assistance to support daily operations • Provide mentorship and training to coders, offering guidance on coding quality, documentation standards, and review methodology • Serve as management back up and support team operations in the manager’s absence. Requirements: • AAPC CPC certification • 1+ year of reviewing coding consultant decisions for quality purposes • 1+ year of developing and implementing quality remediation plans • 1+ year of experience in medical coding in a Fraud, Waste, Abuse and/or error department • Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10 • Experience with researching coding and policies. • Experience with Microsoft products; Excel and Word • Strong attention to detail and ability to review and interpret data. • Demonstrates strong communication skills. Benefits: • medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • bonus eligibility