Senior Autonomous Coding Quality Analyst

Job Posting Closing Date: Open until Filled

Where do you belong?

Your career is more than just a job, it's part of your life. Whether you’re a clinician, or non-clinical professional,  at USACS you'll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work. We care about your success.

USACS also understands that location is important. We offer  career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture,  outstanding benefits and competitive compensation package is best in class.

Job Description

The Senior Autonomous Coding Quality Analyst (SACQA) validates various outputs from artificial intelligence (AI) code sets. The CACQA possesses a deeper understanding of the AI-based fundamental model, application of compliant rule-based coding scenarios while routinely performing internal quality reviews on the AI outputs to ensure adherence to the Coding Quality Assurance Program (CQAP), guidelines, coding policies, SOPs for complete, accurate, and consistent coding that result in appropriate reimbursement and data integrity. The Senior Autonomous Coding Quality Analyst (SACQA) is responsible for the AI creativity and optimization related to clinician documentation deficiencies, predictive modeling, etc. to improve the quality of physician documentation to support code assignments while reducing denials.

Location: Remote

ESSENTIAL JOB FUNCTIONS:

• Pre-autonomous Validation:
  • Responsible for complaint AI build and validation of the AI outputs including MDM scoring, primary and secondary diagnosis codes, CPT codes, MOD, etc.

• Establish and recommend a confident level for MDM, provider, 2nd provider, Dx, Mod, linking prior to AI approval to code autonomously.
• Perform quality assurance reviews on un-codable cases flagged by AI for human review to understand the reasons and produce mitigation plans.
• Track key metrics such as accuracy rates, audit findings, and areas requiring manual review to identify trends and opportunities for improvement.

• Autonomous Validation:
  • Perform quality assurance reviews on all or a percentage of encounters coded autonomously.
  • Perform focused/targeted audits in areas with known compliance risks, such as COPA/Risk, FX care, etc., that are handled by the AI.
  • Based on audit findings, provide feedback to key stakeholders, including the AI Dev team, coding teams, and clinical staff, to improve documentation and coding practices.
  • Track key metrics such as accuracy rates, audit findings, and areas requiring manual review to identify trends and opportunities for improvement.
• Others:

• Master autonomous coding software, understand its underlying logic, and act as a subject matter expert for the organization.
• Stay current on all relevant coding guidelines (e.g., ICD-10, CPT, HCPCS), payer requirements, and government regulations (e.g., CMS, OIG).
• Meets all yearly education requirements and codes records as needed.

• Validate/review of coder comms compliance when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
  • Recommends canned/templated query updates.
  • Quarterly trends and patterns for risk identification and inclusion in the surveillance list.
  • Openly communicates issues and opportunities to the appropriate person(s)
  • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management.
  • Association and the American Academy of Professional Coders, and adheres to official coding guidelines.

KNOWLEDGE, SKILLS AND ABILITIES:

• Expertise in CPT and ICD-10 coding.
• Knowledge of coding guidelines and requirements.
• Knowledge of and skill in using personal computers and terminals in a Windows environment.
• Ability to pay close attention to detail.
• Ability to identify, research, and solve problems and discrepancies.
• Ability to communicate with coworkers and management in a courteous and professional manner.
• Ability to maintain confidentiality.
• Ability to process assigned duties in an organized manner.
• Ability to perform basic mathematical calculations such as adding, subtracting, multiplying, and dividing.
• Ability to work overtime when needed.

EDUCATION AND EXPERIENCE: 

• High school diploma or equivalent, associate degree or higher preferred.
• Coding certification as required by the USACS compliance plan.
• CCS, RHIT or CPC
• Plus CPMA (Auditing Certification)
• At least five years of ED professional coding experience, with demonstrated CAC and/or Autonomous Coding knowledge best practices.
• Must be currently meeting all quality standards.

PHYSICAL DIMENSIONS:

• While performing the duties of this job, the employee is regularly required to sit for prolonged periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds. 
• Required to have close visual acuity to perform the job.

Salary Range:

$59,364.00 - $109,823.00