Lead IP Coding Quality Analyst

Responsibilities

• Serve as an advanced subject matter expert and operational lead responsible for the integrity and defensibility of inpatient coding quality, audit execution, and regulatory compliance.
• Provide day-to-day leadership of coding quality review activities, ensuring alignment between audit findings, coding guidance, education, and enterprise priorities.
• Support development and execution of a structured inpatient coding audit program, including audit tracking, reporting, corrective action planning, and follow‑up validation of sustained improvements.
• Function as a key liaison across Coding, Clinical Documentation Integrity (CDI), Quality, Revenue Cycle, and Compliance to mitigate regulatory risk, prevent DRG downgrades, and ensure accurate representation of patient severity, reimbursement, and publicly reported outcomes.
• Perform advanced inpatient coding audits while providing functional leadership and oversight of coding quality analysts.
• Ensure consistency in audit methodology, interpretation of coding guidelines, and application of regulatory requirements.
• Coordinate audit workflows, validate audit accuracy through secondary reviews, and translate audit findings into actionable insights, education strategies, and performance improvement initiatives.
• Contribute to enterprise audit governance through structured reporting, trend analysis, and participation in compliance and quality initiatives.

Requirements

• Associate degree in Health Information Management, Health Information Technology, or a related field.
• Minimum of 4–8 years of recent inpatient hospital coding experience in an academic medical center or complex acute‑care hospital setting.
• Demonstrated proficiency in ICD‑10‑CM and ICD‑10‑PCS coding, including validation of principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS‑DRG/APR‑DRG assignment.
• Experience reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity, including high‑severity and high‑risk cases.
• Working knowledge of CMS IPPS regulations, OIG compliance expectations, payer audits, DRG validation, and advanced inpatient claim edit frameworks.
• Experience using electronic health records (EHRs) and health information management systems, including encoder, abstracting, and audit/reporting applications.
• Ability to apply independent judgment in evaluating coding, documentation, compliance risk, and audit findings.
• Strong written and verbal communication skills, including the ability to provide clear, educational feedback to coding staff and collaborate with CDI, Revenue Cycle, Quality, and Compliance partners.
• Prior experience in inpatient coding quality review, auditing, denial management, or compliance‑focused roles.
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