Senior Coding Quality Analyst – Special Investigations Unit
Posted 2026-05-06
Remote, USA
Full-time
Immediate Start
- Job Description:
- Perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices
- Conduct comprehensive quality reviews of completed medical coding reviews to ensure coding logic aligns with medical record documentation
- Analyze data, documentation, and evidence to identify potential billing errors, abuse, or fraudulent activity
- Handle complex coding reviews related to legal, compliance, escalations, audits, and rework initiatives
- Prepare detailed written summaries of findings and clearly articulate conclusions to leadership
- Independently research and apply state, CMS, and payer specific guidelines relevant to audits and reviews
- Identify opportunities for process improvements, cost savings, and cases that may warrant prepayment review
- Maintain accurate documentation, records, files, and tracking logs while meeting established deadlines and performance metrics
- Regularly use departmental tools and workflows with minimal assistance to support daily operations
- Provide mentorship and training to coders, offering guidance on coding quality, documentation standards, and review methodology
- Serve as management back up and support team operations in the manager’s absence.
- Requirements:
- AAPC CPC certification
- 1+ year of reviewing coding consultant decisions for quality purposes
- 1+ year of developing and implementing quality remediation plans
- 1+ year of experience in medical coding in a Fraud, Waste, Abuse and/or error department
- Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10
- Experience with researching coding and policies.
- Experience with Microsoft products; Excel and Word
- Strong attention to detail and ability to review and interpret data.
- Demonstrates strong communication skills.
- Benefits:
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- bonus eligibility