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Coding Quality Analyst Location:

Remote Schedule:

Monday - Friday, 8-hour shifts during business hours between 6:00 AM and 6:00

PM EST Employment Type:

Full-Time Position Summary We are seeking a highly skilled Coding Quality Analyst to join a dynamic remote team dedicated to delivering accurate, evidence-based healthcare reimbursement appeals on behalf of clients. This role combines advanced coding expertise, clinical knowledge, and strong analytical writing skills to review medical records, identify coding opportunities, and develop well-supported appeal arguments. The ideal candidate is a self-motivated professional with extensive inpatient coding experience, a deep understanding of DRG methodology, and the ability to thrive in a fast-paced, evolving environment. This individual will work independently while collaborating with physicians, operations teams, intake personnel, leadership, and other cross-functional departments to ensure the highest quality outcomes. Key Responsibilities Review and analyze patient medical records to identify coding and reimbursement opportunities. Extract and evaluate pertinent clinical information to support appeal development. Develop clear, concise, and strongly defensible appeal letters using evidence-based medical literature and coding guidelines. Interpret and apply ICD-9-CM, ICD-10-CM/PCS, CPT, and HCPCS coding standards. Utilize encoder software and DRG methodologies to support accurate coding and reimbursement determinations. Recommend coding revisions that may increase, decrease, or maintain financial impact based on chart review findings. Ensure accurate assignment of diagnostic-related groups (DRGs) and appropriate code selection. Educate clients on compliant coding practices and industry best practices. Participate in Administrative Law Judge (ALJ) tele-hearings as a representative for clients when necessary. Maintain established productivity and turnaround expectations while delivering high-quality work. Perform thorough quality reviews of appeals prior to final submission. Required Qualifications Current coding certification (such as CCS, CCS-P, CPC, RHIA, RHIT, or equivalent). Extensive inpatient hospital coding experience. Expert-level knowledge of AHA Coding Clinic guidance for ICD-9 and ICD-10 coding. Strong understanding of DRG methodologies and reimbursement processes. Experience with outpatient coding. Medicare and Medicaid coding experience. Exceptional written communication and technical writing skills. Strong analytical and critical thinking abilities. Ability to work independently and effectively in a fast-paced environment. Proficiency with Microsoft Word and general computer applications. Preferred Qualifications Active RN license. Experience presenting cases before an Administrative Law Judge (ALJ). Coding audit experience. Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.