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US Acute Care Solutions · 17 hours ago

Senior Autonomous Coding Quality Analyst

United States

Full-time

Onsite

Senior Level

$59K/yr - $110K/yr

5+ years exp

US Acute Care Solutions is a healthcare organization that values connection and support among its staff. They are seeking a Senior Autonomous Coding Quality Analyst who will validate AI outputs, perform quality assurance reviews, and ensure adherence to coding quality standards to improve physician documentation and reduce denials.

Health CareHospitalMedical

Responsibilities

Responsible for complaint AI build and validation of the AI outputs including MDM scoring, primary and secondary diagnosis codes, CPT codes, MOD, etc

Establish and recommend a confident level for MDM, provider, 2nd provider, Dx, Mod, linking prior to AI approval to code autonomously

Perform quality assurance reviews on un-codable cases flagged by AI for human review to understand the reasons and produce mitigation plans

Track key metrics such as accuracy rates, audit findings, and areas requiring manual review to identify trends and opportunities for improvement

Perform quality assurance reviews on all or a percentage of encounters coded autonomously

Perform focused/targeted audits in areas with known compliance risks, such as COPA/Risk, FX care, etc., that are handled by the AI

Based on audit findings, provide feedback to key stakeholders, including the AI Dev team, coding teams, and clinical staff, to improve documentation and coding practices

Track key metrics such as accuracy rates, audit findings, and areas requiring manual review to identify trends and opportunities for improvement

Master autonomous coding software, understand its underlying logic, and act as a subject matter expert for the organization

Stay current on all relevant coding guidelines (e.g., ICD-10, CPT, HCPCS), payer requirements, and government regulations (e.g., CMS, OIG)

Meets all yearly education requirements and codes records as needed

Validate/review of coder comms compliance when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes

Recommends canned/templated query updates

Quarterly trends and patterns for risk identification and inclusion in the surveillance list

Openly communicates issues and opportunities to the appropriate person(s)

Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and the American Academy of Professional Coders, and adheres to official coding guidelines

Qualification

CPT codingICD-10 codingCoding certificationAI validationQuality assuranceMathematical calculationsAttention to detailProblem solvingCommunication skillsOrganizational skills