Facility Coding Quality Specialist

About the Organization

The company helps clients improve their financial health outcomes by supporting the full reimbursement cycle with scalable services, clinical know-how, and analytics-enabled processes. It invests in employee growth and aims to create an environment where professional development and personal success are strongly supported.

Role Overview

This position focuses on advanced review of facility coding work to detect documentation, coding, and billing issues, strengthen compliance, and improve reimbursement accuracy. The role also supports internal coders through feedback, education, reporting, and process improvement initiatives.

Key Duties

The selected professional will conduct detailed retrospective reviews of medical records, evaluate audit results to determine the root cause of errors, and perform secondary checks of diagnosis, procedure, and billing codes. The role includes answering coding and compliance questions, supporting query opportunities for physicians, preparing materials for coders, and documenting work output and time accurately.

Additional responsibilities include maintaining quality benchmarks, tracking coder performance, identifying recurring quality issues, helping refine systems that improve productivity and accuracy, preparing monthly updates, taking part in company training and meetings, and sharing status reports with management when needed. The position also requires protecting patient and client confidentiality and following ethical coding standards, privacy rules, internal policies, and the company’s compliance expectations.

Requirements and Qualifications

Candidates should have at least 2 years of experience, preferably 3 years, in coding and/or auditing for inpatient and outpatient facilities. Experience with customer service support for at least 1 year is also required. A recognized coding credential from AHIMA or AAPC is needed, and RHIA or RHIT may also be accepted. CPC or CCS certification is preferred.

Strong written and verbal communication skills are essential, along with the ability to manage priorities, meet deadlines, work accurately, and handle multiple clients and projects with minimal supervision. Applicants should be comfortable using Microsoft Word and Excel, navigating different EMR systems, and reviewing handwritten charts. Familiarity with telecommuting tools, hospital outpatient billing, APC assignment, documentation rules, coding compliance, and medical necessity standards is strongly preferred.

Working Conditions

Regular, dependable, and punctual attendance is required. The role involves working at a computer terminal for 6 to 8 hours per day, coping with frequent interruptions, and spending long periods seated. Occasional lifting of materials up to 20 lbs may be needed. The work environment can be stressful during busy periods and when multiple deadlines overlap.

Additional Information

This job description is intended as a guideline rather than a complete list of duties. Supervisors may assign additional responsibilities and requirements as needed.

Employees are expected to keep professional coding credentials current, continue building knowledge of reimbursement methods and compliance topics, and actively participate in company-provided education and training.

The role also calls for collaboration with coworkers in a respectful, team-oriented manner and the ability to communicate planned work activities, site visits, and schedule changes to management and relevant staff.

Quality expectations include maintaining an overall coder accuracy level of at least 95% and keeping QA review activity as close to 10% as possible.

Core guideline references include standards from AHA, CMS, AMA, Coding Clinic, CPT Assistant, and AHIMA ethical coding principles.

Protecting personal health information and other confidential company data is a required part of the position.

No salary or stipend details were provided in the source.

No vacancy count, start date, or application deadline was specified.

No internship duration applies to this role.