Lead IP Coding Quality Analyst

Scope of Position

The Lead Inpatient Coding Quality Analyst serves as an advanced subject matter expert and operational lead responsible for the integrity, consistency, and defensibility of inpatient coding quality, audit execution, and regulatory compliance.

This role provides day-to-day leadership of coding quality review activities, ensuring alignment between audit findings, coding guidance, education, and enterprise priorities. The Lead supports the development and execution of a structured inpatient coding audit program, including audit tracking, reporting, corrective action planning, and follow-up validation of sustained improvements.

The position functions as a key liaison across Coding, Clinical Documentation Integrity (CDI), Quality, Revenue Cycle, and Compliance to mitigate regulatory risk, prevent DRG downgrades, and ensure accurate representation of patient severity, reimbursement, and publicly reported outcomes.

Position Summary

The Lead Inpatient Coding Quality Analyst performs advanced inpatient coding audits while providing functional leadership and oversight of coding quality analysts. This role ensures consistency in audit methodology, interpretation of coding guidelines, and application of regulatory requirements.

The Lead is responsible for coordinating audit workflows, validating audit accuracy through secondary reviews, and translating audit findings into actionable insights, education strategies, and performance improvement initiatives.

This position contributes to enterprise audit governance through structured reporting, trend analysis, and participation in compliance and quality initiatives. The role plays a critical part in supporting denial prevention, risk adjustment accuracy, and performance across quality programs including mortality, PSIs, HACs, Vizient, and U.S. News & World Report.

Minimum Qualifications

For Hire

Required

• Associate degree in Health Information Management, Health Information Technology, or a related field.
• Minimum of 4-8 years of recent inpatient hospital coding experience in an academic medical center or complex acute care hospital setting.
• Demonstrated proficiency in ICD-10-CM and ICD-10-PCS coding, including validation of principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS-DRG/APR-DRG assignment.
• Experience reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity, including high-severity and high-risk cases.
• Working knowledge of CMS IPPS regulations, OIG compliance expectations, payer audits, DRG validation, and advanced inpatient claim edit frameworks.
• Experience using electronic health records (EHRs) and health information management systems, including encoder, abstracting, and audit/reporting applications.
• Ability to apply independent judgment in evaluating coding, documentation, compliance risk, and audit findings.
• Strong written and verbal communication skills, including the ability to provide clear, educational feedback to coding staff and collaborate with CDI, Revenue Cycle, Quality, and Compliance partners.

Preferred

• Bachelor's degree in Health Information Administration, Health Information Management, or a related healthcare discipline.
• Prior experience in inpatient coding quality review, auditing, denial management, or compliance-focused roles.
• Experience in: Academic medical center or large health system; Mortality review and quality metrics (PSI, HAC, Vizient, USNWR); Denial management and appeals; Coding education, training, or onboarding; Audit program development or standardization efforts.
• Demonstrated informal leadership experience (lead, mentor, SME, or preceptor role)

Certification Requirements

One of the following credentials required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS). Certification must be maintained in good standing.

Ongoing Requirements

• Maintain required continuing education credits (CEUs) in accordance with AHIMA credential standards.
• Participate in required coding, quality, audit, and departmental meetings.
• Complete all mandatory health system training and hospital-based learning modules (CBLs) in a timely manner.
• Maintain current knowledge of inpatient coding guidelines, regulatory updates, and compliance initiatives.