Senior Coding Quality Analyst (CPC)

About the role

Work centres on record reviews across medical, behavioral health and transportation claims, where correct coding and clear findings matter. Analysts also coach coders and cover for the manager when needed.

At a glance

What you will do

• Review completed coding audits to confirm the logic matches the record, CPT, HCPCS and ICD-10 rules, and payer and federal requirements
• Examine claims and documentation for billing errors, abuse or fraud, including patterns and trends
• Write up findings and conclusions for leadership, and research state, CMS and payer guidelines on your own
• Mentor coders on quality, documentation standards and review method, and back up the manager

What they look for

• AAPC CPC certification
• At least a year reviewing coding consultant decisions for quality
• At least a year building and carrying out quality remediation plans
• At least a year coding in a fraud, waste, abuse or error department
• Familiarity with CPT, HCPCS and ICD-10, policy research, and Excel and Word

Nice to have

• CPMA certification
• Strong analytical and communication skills with close attention to detail