Medical Coding Quality Analyst

Job description

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