Quality Reporting and Coding Analyst

HOPE Clinic•Houston, TX

About The Position

The Quality Reporting & Coding Analyst supports HOPE Clinic’s quality reporting, coding accuracy, payer performance tracking, and provider education initiatives to ensure compliance with payer, regulatory, and organizational requirements. This Quality Reporting & Coding Analyst manages HEDIS (Healthcare Effectiveness Data and Information Set) and other quality measure reporting, supports accurate clinical documentation and coding, coordinates coding-related training for providers and billing staff, and assists with payer contract review and quality metric oversight. The position works collaboratively in a multidisciplinary team to support quality measure performance.

Requirements

Excellent written and oral communication skills
Strong planning and organization skills with the ability to keep/produce accurate notes, records, and detailed-oriented work
Knowledge of HEDIS principles and guidelines
Knowledge of ICD-10, CPT coding
Knowledge of HIPAA Privacy and Security Rules
Knowledge of medical terminology and concepts of managed health care
Working knowledge of the methods and techniques of abstracting clinical information from medical records
Proficient in Microsoft Office Suite (Word, Excel, Outlook, Access, etc.) and database software
Ability to multitask and work in a fast-paced environment
Ability to understand, interpret and consistently apply clinical audit criteria
Ability to accurately evaluate medical records and other health care data
Ability to maintain a less than 2% error rate in record abstraction and data entry
Ability to maintain confidentiality and security of sensitive medical information
Ability to navigate multiple windows while operating a computer
Ability to think and work effectively under pressure
Ability to function effectively within multidisciplinary teams
Associate’s degree in science, health information technology, coding, or in a related field required
Certification in medical coding (CPC, CCS, or equivalent) is required
Minimum of 3 years of healthcare experience is required
Healthcare experience must include experience in quality measures/improvement or related experience
Must have good transportation and a valid Texas Driver’s license.

Nice To Haves

Bachelor’s degree preferred
eClinicalWorks (eCW) experience preferred
FQHC experience is a plus!
Bilingual (Vietnamese, Chinese, Arabic and/or Spanish with English) is preferred
Above average skills in language ability as well as public speaking and writing
Excellent telephone etiquette

Responsibilities

Manage and support HEDIS and other payer and regulatory quality measure reporting
Perform chart reviews and data validation to ensure accurate and complete measure capture
Monitor quality performance trends and identify documentation, coding, or care-gap issues
Establish and maintain effective and cooperative working relationships with HOPE Clinic providers, staff, and other individuals working with the clinic
Serve as a point of contact with payers regarding quality metrics, measure definitions, and reporting requirements
Maintain a summary of quality measures, reporting timelines, and performance requirements for each payer
Provide education and guidance to providers on accurate clinical documentation and coding practices
Serve as a resource for coding-related questions for providers and billing staff
Assist with coding audits, reviews, and follow-up education as needed
Plan, schedule, and coordinate annual coding and documentation training for providers and billing staff
Perform onboarding and refresher training related to coding and quality reporting
Maintain documentation of training materials and attendance
Review payer contracts related to quality metrics, reporting requirements, and incentive structures
Summarize contract terms and quality-related provisions for CFO review and approval
Maintain an organized repository and summary of payer contracts, including quality measures, reporting timelines, and performance expectations
Work collaboratively with the Quality Improvement to track performance and address quality measure gaps
Coordinate with the Call Center and Clinical Operations to support patient outreach and appointment follow-up related to quality metrics
Assist in identifying patients due for services required to meet quality measures and support outreach efforts to improve appointment completion
Collaborate with Finance, Billing, Quality Improvement, Clinical Operations, and the Call Center to support accurate reporting and reimbursement
Assist with preparation for audits, payer reviews, and site visits related to quality reporting and coding
Support compliance with HRSA, payer, and internal documentation standards
Attend on-site/off-site community engagement activities, clinic events, and/or training as needed
Perform other duties as assigned to support HOPE Clinic’s Mission, Vision and Values.