Quality Analyst Jobs

About The Position

Requirements

• High school diploma required.
• Five or more years of inpatient facility coding, auditing, payment integrity, reimbursement review, quality review, audit validation, or related healthcare experience preferred.
• Strong understanding of ICD-10-CM/PCS, inpatient facility claim review, medical record abstraction, documentation validation, payer reimbursement methodologies, audit scoring, and the relationship between documentation, coded data, IRF-PAI elements, and reimbursement outcomes.
• Ability to review lengthy medical records and connect documentation to reimbursement impact, treatment during the IRF stay, payer/client requirements, and audit support.
• Experience identifying quality errors, missed opportunities, documentation gaps, inconsistent audit application, and trends in complex inpatient or IRF audit work.
• Strong analytical, problem-solving, root cause analysis, critical-thinking, and attention-to-detail skills.
• Ability to evaluate auditor work objectively, identify unsupported conclusions, and distinguish IRF-PAI documentation requirements from traditional acute-care DRG coding logic.
• Ability to synthesize complex IRF medical record documentation and make objective, evidence-based quality determinations.
• Excellent written and verbal communication skills, including providing professional feedback, writing clear quality rationales, explaining audit decisions, and communicating trends to leadership.
• Ability to work independently in a remote environment while maintaining quality, productivity, confidentiality, and timely completion of reviews.
• Proficiency in Excel, Word, Outlook, OneNote, and general computer applications.
• Commitment to teamwork, calibration, continuous learning, consistent quality application, process improvement, and accurate audit outcomes.
• Required skill areas include IRF quality review, IRF-PAI validation, IRF PPS/HIPPS methodology, ICD-10-CM/PCS, medical record review, audit sampling, quality scoring, documentation validation, root cause analysis, quality feedback, calibration, trend identification, written communication, and HIPAA compliance.

Nice To Haves

• Associate’s or bachelor’s degree in Health Information Management, healthcare administration, nursing, rehabilitation services, or a related healthcare field.
• CCS, RHIA, RHIT, CIC, CPC, or comparable coding credential; multiple coding credentials strongly preferred.
• Demonstrated IRF audit, IRF coding, IRF reimbursement, IRF-PAI, or rehabilitation facility documentation review experience.
• Prior experience reviewing IRF audits, IRF-PAI documentation, IRF PPS/HIPPS methodology, rehabilitation facility documentation, inpatient rehabilitation reimbursement, or audit quality monitoring.
• Clinical licensure, rehabilitation facility experience, or prior IRF medical necessity review experience when the client scope includes clinical review components.
• Experience with audit workflow tools, coding references, encoder tools, and medical record review platforms.

Responsibilities

• Evaluate the accuracy and consistency of completed IRF Auditor work using IRF audit, coding, reimbursement, and documentation expertise.
• Perform random, targeted, follow-up, and focused quality reviews to validate audit findings and no-findings, supporting documentation, coding logic, reimbursement impact, and rationale.
• Follow approved sampling methodology and review procedures, applying established quality scoring criteria consistently and objectively.
• Confirm that audit determinations are supported by relevant IRF records, documentation, CMS/IRF-PAI guidance, payer requirements, and internal procedures.
• Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, onset date, comorbid conditions, treatment during the IRF stay, and reimbursement support.
• Review audit documentation for clarity, completeness, grammar, evidence-based support, and alignment with quality and communication expectations.
• Identify documentation, coding, and reimbursement discrepancies that may affect IRF payment, including unsupported diagnoses or comorbidities, unsupported carry-forward diagnoses, mismatches between records and conclusions, and missed review or escalation opportunities.
• Provide specific, professional, actionable feedback and coaching to IRF Auditors based on review outcomes.
• Identify trends, recurring errors, documentation gaps, inconsistent audit logic, and potential process or training needs.
• Perform root cause analysis and recommend corrective actions to improve accuracy, documentation quality, productivity, consistency, and performance.
• Support calibration discussions, quality monitoring, score reviews, standard operating procedure updates, and training opportunities.
• Write professional communications documenting review outcomes, findings, rationale, trends, coaching recommendations, and next steps.
• Maintain quality review results and reporting for performance monitoring, trend analysis, leadership review, coaching, and continuous improvement.
• Communicate quality results, barriers, risks, trends, and improvement recommendations to peers and management in a timely, professional manner.
• Stay current with IRF reimbursement updates, CMS and IRF-PAI guidance, ICD-10-CM/PCS updates, payer policies, and internal procedures.
• Perform all duties in accordance with company Compliance, Information Security, HIPAA, regulatory policies, procedures, and programs.