Medical Coding Quality Analyst

<h3></h3> <p><strong>Job Title</strong></p> <p>Quality Control Analyst (QCA) – Medical Coding</p> <p><strong>Experience</strong></p> <p>4–5 years in Medical Coding (with auditing/QC exposure preferred)</p> <p><strong>Job Summary</strong></p> <p>The Quality Control Analyst (QCA) is responsible for auditing and ensuring the accuracy and compliance of medical coding across Evaluation & Management (E&M), Outpatient (OP), Inpatient (IP), and Surgery coding. The role involves reviewing coded charts, identifying errors, providing feedback, and driving quality improvements in alignment with coding standards and client requirements.</p> <p><strong>Key Responsibilities</strong></p> <ul> <li>Perform quality audits on coding for E&M, OP, IP, and Surgical cases</li> <li>Validate accurate assignment of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes</li> <li>Ensure compliance with AAPC/AHIMA guidelines, payer policies, and client SOPs</li> <li>Identify coding errors, gaps, and documentation deficiencies</li> <li>Provide detailed feedback and coaching to coders to improve quality</li> <li>Track and report quality metrics, error trends, and audit findings</li> <li>Conduct calibration calls with internal teams and refresher sessions for existing coder</li> <li>Support denial analysis and prevention strategies</li> <li>Ensure adherence to TAT, productivity, and accuracy benchmarks</li> </ul> <p><strong>Required Skills & Competencies</strong></p> <ul> <li>Strong expertise in E&M coding</li> <li>Outpatient and Inpatient coding</li> <li>Surgical coding (CPT & ICD-10-PCS)</li> <li>In-depth knowledge of ICD-10-CM, CPT, HCPCS</li> <li>Knowledge of NCCI edits and modifier usage</li> <li>Excellent auditing and analytical skills</li> <li>Strong communication and feedback delivery skills</li> <li>Proficiency in Excel and reporting tools</li> </ul> <p><strong>Qualifications</strong></p> <ul> <li>Graduate in Life Sciences / Medical / Paramedical field</li> <li>Certifications such as CPC / CCS / CIC preferred</li> </ul> <p><strong>Key Performance Indicators (KPIs)</strong></p> <ul> <li>Audit accuracy (%)</li> <li>Error detection rate</li> <li>Reduction in repeat errors</li> <li>Adherence to SLA/TAT</li> <li>Team quality improvement metrics</li> </ul> <p> </p>