Position Summary
The Quality Analyst – Surgery is responsible for performing detailed coding quality reviews, audits, and education related to surgical services. This role ensures accurate code assignment, documentation integrity, and compliance with federal regulations, payer policies, and organizational standards. The analyst partners closely with coding staff, providers, and leadership to drive continuous improvement in coding accuracy, reduce compliance risk, and support optimal reimbursement.
Key Responsibilities
- Perform retrospective and prospective coding audits for surgical specialties (e.g., general surgery, cardiovascular, orthopedic, etc.)
- Evaluate coding accuracy for CPT, ICD-10-CM/PCS, and modifiers, ensuring compliance with:
- Official Coding Guidelines
- NCCI edits
- CMS and payer-specific policies
- Identify trends, root causes, and opportunities for improvement in coding quality and documentation
- Develop and deliver targeted education and feedback to coders and providers
- Collaborate with leadership to implement coding quality initiatives and process improvements
- Monitor and report key quality metrics (accuracy rates, audit scores, denial trends)
- Support internal and external audits, including RAC, payer, and regulatory reviews
- Assist with development of policies, procedures, and training tools
- Provide guidance on complex surgical coding scenarios
- Participate in denial management and appeal support related to coding issues
Qualifications
Required
- One of the following certifications:
- Minimum 5+ years of surgical coding experience, with strong focus on complex procedural coding
- Minimum 2+ years of auditing or quality review experience
- Advanced knowledge of:
- Surgical coding across multiple specialties
- CPT/HCPCS coding and modifier usage
- ICD-10-CM/PCS
- NCCI edits and bundling rules
- Strong understanding of documentation requirements for surgical procedures
Preferred
- Prior experience developing education/training programs
- Familiarity with encoder tools, EHRs and audit software
- Experience with denial analysis and revenue cycle impact
Skills & Competencies
- Strong analytical and critical thinking skills
- High level of attention to detail and accuracy
- Ability to interpret complex operative reports
- Confident communicator with ability to provide constructive feedback
- Ability to identify trends and implement process improvements
- Organizational and time management skills in a high-volume environment
Why Join Us
- Opportunity to lead quality improvements in surgical coding
- Collaborative, forward-thinking leadership environment
- Impactful role supporting compliance, accuracy, and financial performance
