Sr. Coding Quality Analyst

The US Oncology Network is looking for a Sr. Coding Quality Analyst to join our team at Texas Oncology. This full-time hybrid position will support the Coding Department at our 3001

E. President George Bush Hwy Suite 100 location in Richardson, Texas. Typical work week is Monday through Friday 8:30a - 5:00p.

This position will be level 1 based on relevant candidate experience.

As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby.

Our mission is still the same today-at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.

The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

Under minimal supervision, performs comprehensive reviews and investigations involving coding, documentation, billing, reimbursement, systems, workflows, and operational processes. Reviews may originate within Coding Operations or from business partners and organizational stakeholders requiring coding and operational expertise. Evaluates concerns from all applicable perspectives to determine the root cause, scope, impact, and appropriate resolution. Determines whether identified concerns are related to coding, documentation, billing, system configuration, workflow, process design, staff or provider education, operational practices, payer requirements, or a combination of factors.

Conducts audits, investigative research, data validation, claim review, and medical record review before issuing findings or recommendations. Coordinates with Coding Operations, Audit Operations, Education, Operations, Revenue Cycle, Information Technology, Compliance, reimbursement, clinical leadership, and other departments as necessary to obtain complete information and resolve identified issues. Tracks findings, recommendations, and corrective actions through completion. Validates that corrective actions effectively resolved the identified issue and communicates final outcomes to the appropriate stakeholders.

Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Performs complex reviews and investigations involving coding, documentation, billing, reimbursement, systems, workflows, operational processes, and related quality concerns.
• Receives and evaluates review requests originating within Coding Operations or from organizational stakeholders requiring coding and operational expertise.
• Establishes the appropriate scope and review methodology based on the reported concern, potential risk, available information, and affected services or processes.
• Reviews medical records, provider documentation, coding, charges, claims, billing activity, system configuration, operational workflows, policies, procedures, and supporting data to determine the facts and circumstances related to each concern.
• Evaluates concerns from all applicable perspectives and does not limit the investigation to the initially reported issue or assumed cause.
• Determines whether the identified issue is related to coding, documentation, billing, reimbursement, payer requirements, system configuration, workflow, process design, training, staff activity, provider activity, or a combination of factors.
• Conducts focused audits, medical record reviews, claim reviews, data validation, coding validation, and other investigative activities necessary to confirm the concern and determine its scope.
• Researches applicable CPT, HCPCS, ICD-10-CM, CMS, Medicare Administrative Contractor, National…