Quality Coding Analyst

Newport Mental Health•Middletown, RI

21h

About The Position

The Quality Coding Analyst supports the organization’s quality reporting and reimbursement objectives by ensuring complete, accurate, and compliant clinical quality measure (CQM/eCQM) coding and data capture. This role partners with clinical, quality, HIM, revenue cycle, and IT teams to validate documentation, abstract and code quality measure data elements, and troubleshoot measure logic and workflows. The analyst also applies healthcare billing management expertise to align coding and billing practices, optimize reimbursement, and reduce denials and audit risk.

Requirements

3+ years of experience in quality measure abstraction/coding and/or healthcare coding, HIM, revenue cycle, or related roles.
Hands-on experience working with quality measures (CQM/eCQM or payer programs) and measure specifications.
Hands-on healthcare billing management experience (claims workflow, charge capture, denials, edits, or payer requirements).
Knowledge of ICD-10-CM and CPT/HCPCS coding concepts and clinical documentation standards.
Experience using an EHR and reporting tools; strong Excel skills required.
Excellent attention to detail and the ability to communicate findings and recommendations

Responsibilities

Perform quality measure abstraction and coding for assigned programs (e.g., CMS quality programs, payer quality initiatives, HEDIS-like measures, internal quality dashboards), ensuring adherence to measure specifications, documentation requirements, and submission timelines.
Validate clinical documentation and coded data (ICD-10-CM/PCS, CPT/HCPCS, modifiers as applicable) to support accurate quality measure numerator/denominator assignment and reporting.
Partner with Quality and Clinical Informatics to improve workflows and EHR documentation tools that drive accurate data capture for quality measures (e.g., problem list, flowsheets, smart forms, order sets).
Support electronic clinical quality measure (eCQM) logic review, including mapping of data elements, value sets, and code sets; identify gaps and recommend fixes.
Conduct quality data audits and reconciliations across the EHR, registries, and reporting tools; investigate discrepancies and implement corrective actions.
Leverage healthcare billing management experience to align quality coding with charge capture and billing practices; identify documentation/coding opportunities that improve both quality performance and reimbursement integrity.
Submit, track, and manage electronic claims using our billing software
Keep detailed, organized records that support smooth operations
Serves as liaison with the Information Services Department and outside consultants to address computer and software upgrades, training needs and problem resolution.
Establishes and updates Billing Department policies and procedures according to Medicare and Medicaid regulations and other payer requirements.
Establishes and maintains daily, weekly and monthly protocols for on-going monitoring of Billing Department’s workload to gain departmental efficiency.
Ensures accuracy of billing revenues and other financial data used for internal and external reporting by ensuring that payers are billed at the correct rates and resolving payment denials and other payment-related problems.
Collaborate with Revenue Cycle/HIM on coding edits, denial trends, and payer requirements; support appeals with documentation and coding rationale when related to quality or clinical validation.
Ensures that cash receipt postings are reconciled to a daily or batch total and that deposits are forwarded to the Finance Department for timely banking and general ledger posting.
Analyzes Accounts Receivable data by payer, program, clinician and other variables to minimize 90-day aged receivables.
Prepare and maintain measure documentation (work instructions, audit trails, data definitions, and reporting evidence) to support internal and external audits.
Develop routine and ad hoc reports, summaries, and presentations for stakeholders; translate measure outcomes into actionable findings.
Maintain knowledge of applicable regulations and guidance (HIPAA, CMS quality reporting guidance, official coding guidelines, and payer policies as applicable).
Perform all other duties as assigned by Supervisor or Manager.
Attend trainings and meetings as assigned.
Adhere to safety policies including participation in fire/disaster drills.