Coding Quality Analyst

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

3/16/2026

Entity:

Wisconsin

Job Code:

450008

Job Title:

Coding Quality Analyst

FLSA Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

JOB SUMMARY

In accordance with both Official and UW Health Coding Guidelines, the Coding Quality Analyst will assess and review the overall quality of coding on any accounts completed by Medical Coding Specialists (MCS).  Quality reviews can be evaluated pre-bill or post-bill, ensuring adherence to workflows and ethical coding.  The position requires advanced knowledge of outpatient coding (CPT, ICD-10-CM and HCPCS).

For HCC-specific Coding Quality Analysts, the Analyst will also follow Official Coding Guidelines for Coding and Reporting and Risk Adjustment for Hierarchical Condition Categories (HCC).  HCC Coding is a risk adjustment model designed to estimate future costs for patients.

The incumbent is responsible for designing and implementing quality coding audit programs and communicating audit findings and recommendations to coding management. The position obtains statistics and the information necessary to assess risk for all areas of coding. In addition, the Coding Quality Analyst will assess the validity of external coding reviews from 3rd party auditors and Governmental agencies.  The incumbent will review medical records where an external coding review has been received which may result in a change in reimbursement.

ESSENTIAL DUTIES

•

Apply official CPT and ICD-10 coding guidelines, internal guidelines, and Medicare/Medicaid specific coding instructions to review and analyze coded services and coding queries.

•

Develop, conduct, and/or coordinate the audit process for coding quality, this includes but is not limited to: analyzing errors and formulating advice/education, identifying and advising staff on quality improvement opportunities, participating in individualized feedback for coding staff, and summarizing results and identifying trends for specific educational opportunities.

•

Keep the coding team updated on the status of proposed changes to Medicare reimbursement policies and procedures.

•

Prepare summary reporting of the coding review results as requested.

•

Develop and implement organized monitoring system for the QA program structure.

•

Develop and maintain functional training materials for all Outpatient Coding areas.

•

Assist with education in-services for physicians, other providers and clinical staff relating to documentation, coding and charging guidelines.

•

Participate in other coding-related projects as assigned and provide general back-up for the Coding Department.

•

Contribute to the maintenance of UW Health’s Internal Coding Guidelines and partner with departments and/or UW Health teams to ensure all documentation is available for coding.

•

Identify trends for specific educational opportunities for providers.

•

Participate in training new coding staff, as needed.

•

HCC-specific Analysts:
-Perform Retrospective Reviews for all HCC patients.
-Develop HCC Coding Guidelines for Medical Coding Specialists.
-Collaborate with OP CDI staff and develop and maintain training materials for all HCC Coding areas.
-Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

High School Diploma

or equivalent and Medical Coding Program Graduate. Two (2) years of relevant coding experience may be considered in lieu of Medical Coding Program).

Required

Graduate of a Health Information Technology program

Preferred

Non-HCC roles: Experience with coding concepts (Current Procedural Terminology (CPT), International Classification of Disease 10th Edition-Clinical Modification (ICD-10-CM), and Health Care Procedure Coding System (HCPCS)

HCC-specific roles: Experience in HCC Risk Adjustment Coding

Required

and

3 years

progressive coding experience (for non-HCC roles) or 3 years of experience in HCC Risk Adjustment (for HCC roles)

Required

3 years

progressive coding experience in multiple specialties (non-HCC roles) or 3 years HCC Risk Adjustment Coding at a large health system or academic medical center (for HCC roles)

Preferred

For Non-HCC roles: Certification as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P)

Upon Hire

Required

For HCC-specific roles: Certified Risk Adjustment Coder (CRC)

within 1 Year

Required

Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

Extensive knowledge of medical terminology

•

Extensive knowledge of Anatomy and Physiology

•

Demonstrated capacity to work independently

•

Effective communication skills, written and oral

•

Proven organizational and time management skills

•

Strong interpersonal skills

•

Ability to work independently and self-motivate as well as motivate others

•

Ability to meet deadlines

•

Analytical skills with ability to manipulate and interpret data

•

Ability to problem solve and make independent decisions

•

Ability to multi-task

•

Ability to collaborate and promote teamwork

•

Experience using Microsoft Office (Excel, Word, PowerPoint, Visio)

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that they can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If someone can do medium work, we determine that they can also do sedentary and light work.

20-50#

10-25#

Negligible-10#

☐

Heavy: Heavy work involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If someone can do heavy work, we determine that they can also do medium, light, and sedentary work.

50-100#

25-50#

10-20#

☐

Very Heavy: Very heavy work involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If someone can do very heavy work, we determine that they can also do heavy, medium, light, and sedentary work.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.