Coding Quality Analyst - Inpat

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

JOB INFORMATION

Effective Date:

2/3/2026

Entity:

Wisconsin

Job Code:

450014

Job Title:

Coding Quality Analyst - Inpat

FLSA Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

JOB SUMMARY

Under general supervision, the Coding Quality Analyst Inpatient will assess the overall quality of coding on any accounts submitted to billing. The incumbent will review medical records prior to release and alert management to potential coding or DRG issues.  This position will also be responsible for daily operational activities, including but not limited to responding to coding questions, performing Quality Audits, performing focused secondary pre-bill coding reviews, training new employees and providing ongoing education for all inpatient coding staff.

The incumbent is responsible for designing and implementing quality coding audit programs and communicating audit findings and recommendations to the Manager and Supervisor. The position obtains statistics and the information necessary to maintain an audit risk assessment system for all auditable areas. The Coding Quality Analyst Inpatient will also participate in the DRG Reconciliation review process in collaboration with the Clinical Documentation Integrity (CDI) Team, including Quality Analysts, Specialists, Manager and Supervisor.

In addition, the incumbent will assess the validity of external coding reviews from governmental and non-governmental parties.  The incumbent will review medical records based on external coding reviews which may result in changes to reimbursement, and the incumbent will participate in the denial appeal process.

As assigned by the Inpatient Manager and/or Supervisor, the incumbent has the authority to review and evaluate all coding areas within UW Health. The incumbent must conduct audit work in compliance with the standards for the professional practice as identified by Official Coding Guidelines and any other applicable official resources.

ESSENTIAL DUTIES

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Apply appropriate Official Coding Guidelines, UW Health internal coding guidelines and CMS regulations to review and analyze coded inpatient records.

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Design and implement quality audits that adequately reflect established policies and procedures using standard auditing techniques. Perform retrospective and concurrent audits to ensure coding accuracy and compliant reporting. Summarize results for coding management or other internal groups as appropriate and participate in feedback and coaching to individual coders based on findings.

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Maintain a database of external coding reviews to track potential areas of concern. Prepare summaries and reporting based on coding review results.

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Assess the accuracy and completeness of inpatient cases. Thoroughly review coded accounts and recommend coding changes where applicable. Evaluate workflows and procedures to gain efficiencies and strengthen controls; report all significant audit findings to Inpatient Coding Manager and/or Supervisor. Prepare and maintain all completed audits, documenting the basis for recommended changes.

•

Provide feedback of audit results to coding staff in a professional manner and emphasize the educational properties of the audit; prepare and present educational materials to coding staff as appropriate.

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Review and respond to coding questions from staff on current charts in a clear and concise manner.

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Participate in the DRG Reconciliation process in collaboration with the CDI Team.

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Review and evaluate diagnosis/procedure codes assigned on accounts as requested by external auditors. Compose appeal letters in a professional and objective manner.

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Update the Billing Office of the status of proposed DRG changes that require updated claim submissions.

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Participate in other coding quality/DRG analysis projects as assigned.

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Assist in the training of new employees by developing training curriculum and orienting new employees to the facility’s coding practices, internal guidelines and workflows. Mentor and coach coding staff, as appropriate and provide general back-up for the Inpatient Coding Department.

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

Required

Graduate of a Health Information Technology program

Preferred

3 years

of progressive acute care hospital inpatient coding experience to include experience coding MS-DRGs and APR-DRGs

Required

5 years

or more of inpatient coding experience in an academic medical center.

Preferred

Experience with coding quality audits and improvement projects

Preferred

Training experience

Preferred

Certified Coding Specialist (CCS), or Certified Inpatient Coder (CIC)

Required

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

Preferred

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

•

Training in the use of ICD-10-CM and ICD-10-PCS coding systems

•

Formal training in reimbursement systems--IPPS, DRGs,etc

•

Advanced knowledge of, but not limited to, current Official Coding Guidelines and methodologies, MS-DRGs, APR-DRGs, the ICD-10-CM/PCS coding systems and conventions

•

Extensive knowledge of medical terminology, anatomy and pathophysiology, pharmacology and ancillary test results

•

Extensive knowledge of complex medical and coding concepts encountered in an Academic Medical Center and Level 1 Trauma Center

•

Advanced knowledge of regulatory requirements of Inpatient Prospective Payment System (IPPS) and other payer requirements

•

Strong communication skills (interpersonal, verbal and written)

•

Proficiency in Office applications (Excel and Access) preferred

•

Proven skills in use of encoder grouping and abstracting software

•

Excellent organizational skills, and ability to meet deadlines

•

Excellent analytical skills

•

Excellent interpersonal skills

•

Ability to work independently

•

Ability to exercise good judgment

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.