Quality Reporting and Coding Analyst at Asian American Health Coalition – Houston, Texas

POSITION TITLE: Quality Reporting & Coding Analyst

LOCATION: HOPE Clinic – Alief/HOPE Health and Wellness Center

REPORTS TO: Chief Financial Officer

EDUCATION: Associate’s degree in science, health information technology, coding, or in a related field required; bachelor’s degree preferred. Certification in medical coding (CPC, CCS, or equivalent) is required

WORK EXPERIENCE: Minimum of 3 years of healthcare experience is required. Healthcare experience must include experience in quality measures/improvement or related experience, eClinicalWorks experience preferred. FQHC experience is a plus!

SALARY RANGE: DOE

FLSA STATUS: Exempt or Non-Exempt

POSITION TYPE: Full-Time

LANGUAGE: Fluent in English; Bilingual in English and Spanish, Arabic, Burmese, Chinese or other languages is preferred

HOPE Clinic provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

JOB SUMMARY:

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.

MAJOR DUTIES & 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.

QUALIFICATION 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.

EDUCATION and/or EXPERIENCE:

• Associate’s degree in science, health information technology, coding, or in a related field required;
• Bachelor’s degree preferred;
• 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;
• eClinicalWorks (eCW) experience preferred;
• FQHC experience is a plus!

OTHER SKILLS and ABILITIES:

• 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;
• Must have good transportation and a valid Texas Driver’s license.