Medical Coding – QA

Key Responsibilities

Coding Quality Review & Audits

• Perform retrospective and concurrent audits on coded medical records to ensure accuracy, completeness, and compliance.

• Review coding across ICD-10-CM, ICD-10-PCS, CPT, and HCPCS, depending on specialty scope.

• Validate correct assignment of diagnoses, procedures, modifiers, DRGs, and levels of service.

• Identify coding errors, trends, and root causes impacting quality and reimbursement.

Quality Improvement & Feedback

• Ensure coders meet established quality benchmarks (≥ 95% accuracy).

• Provide constructive, actionable feedback to coders to improve accuracy and consistency.

• Develop and maintain audit reports, scorecards, and quality metrics.

• Support the reduction of denials, rework, and audit risks through targeted quality initiatives.

Compliance & Regulatory Standards

• Ensure adherence to CMS, Medicare, payer-specific, and official coding guidelines.

• Maintain strict HIPAA compliance and confidentiality of PHI.

• Follow internal SOPs, QA frameworks, and compliance policies.

Collaboration & Training

• Work closely with coding teams, team leads, operations managers, CDI, and compliance teams.

• Support coder training, refresher sessions, and guideline updates based on audit findings.

• Participate in calibration sessions to ensure audit consistency.

Continuous Learning

• Stay current with annual coding updates, Coding Clinic guidance, CMS changes, and payer policies.

• Contribute to continuous process improvement and quality enhancement initiatives.

Qualifications & Skills

Education

• Bachelor’s degree in Life Sciences, Nursing, Pharmacy, or a related field (preferred).

Experience

• 2+ years of experience in Medical Coding, with a minimum of 1 year in a QA / Auditor role.

• Hands-on exposure to multi-specialty coding (IP-DRG, Surgery, E&M, ED preferred).

• Experience conducting formal coding audits and quality reviews.

Certifications (Mandatory)

• An active coding certification is required.

• Accepted certifications include:

  • CPC

  • COC

  • CCS

• QA-specific credentials (e.g., CPMA) are an added advantage.

• Candidates without certification are not eligible.

Skills

• Strong command of coding guidelines and audit methodologies.

• Excellent analytical and attention-to-detail skills.

• Ability to identify trends, document findings, and recommend corrective actions.

• Strong written and verbal communication skills for feedback and reporting.

• Ability to work independently and manage multiple audits.