Surgery - Quality Analyst

Required Qualifications

• Minimum 4-8 years of experience in surgery coding.
• Certified Professional Coder (CPC) credential.
• Strong knowledge of surgery coding guidelines, CPT, ICD-10, modifiers, and HCPCS codes.
• Strong analytical skills with the ability to identify coding discrepancies and trends.
• Familiarity with auditing tools and techniques.
• Excellent verbal and written communication skills.
• Ability to code across multiple specialties, including:
• Cardiothoracic
• Vascular

• Orthopedics
• General Surgery
• Ophthalmology
• OBGYN
• Plastics
• Oncology
• Radiation Therapy

Preferred Qualifications

• Ability to work independently while collaborating effectively with multiple teams.
• Experience in providing training and leading coding improvement initiatives.

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Key Responsibilities

• Conduct audits on surgery codes, ensuring accurate application of CPT, ICD-10, and HCPCS codes based on medical records.
• Identify discrepancies such as over-coding, under-coding, or insufficient documentation, and provide actionable feedback.
• Prepare and present detailed audit reports, including findings, trends, and recommendations for improvement.
• Identify error categories, perform root cause analysis (RCA), and implement corrective and preventive actions (CAPA).
• Conduct one-on-one coaching sessions with bottom quartile performers to improve coding accuracy.
• Monitor compliance with internal policies, coding guidelines, and regulatory standards related to surgery codes.
• Collaborate with Operations Surgery coders to resolve audit findings and ensure corrective actions are implemented.
• Recommend process enhancements and best practices to improve surgery coding accuracy and efficiency.