Job Summary
The Quality Analyst is responsible for auditing coded medical records with a primary focus on Profee Surgery speciality to ensure coding accuracy, compliance with regulatory standards, and adherence to payer guidelines.
The role involves reviewing Surgery medical records across multiple specialties and validating correct code assignment within the 10000 to 60000 CPT sections using the Current Procedural Terminology (CPT), ICD-10-CM, Modifiers and HCPCS Level II code sets.
The Quality Analyst will identify coding discrepancies, provide feedback and training to coding teams, monitor quality metrics, and ensure compliance with payer policies and regulatory guidelines.
Key Responsibilities
-
Expertise: In-depth knowledge of Profee surgery coding guidelines, CPT, ICD-10-CM, HCPCS Level II codes & Modifiers.
-
In-depth knowledge in auditing multiple specialties such as Orthopaedics, Family practice, OBGYN, Neurology, Oncology, Gastrointestinal etc.
-
Validate and ensure the correct assignment of CPT, ICD-10-CM, HCPCS Level II codes & Modifiers.
-
Identify coding errors, documentation gaps, and compliance risks.
-
Monitor coding quality benchmarks and maintain audit accuracy standards.
-
Provide feedback, coaching, and training to coding teams based on audit findings.
-
Support coding accuracy improvement initiatives and process optimization.
-
Stay updated with coding guideline updates, payer policies, and regulatory changes.
-
Utilize coding software, encoder tools, and electronic health record (EHR) systems to ensure accurate charge capture and documentation.
-
Meet established audit productivity and quality standards.
-
Assist in resolving coding denials and appeals when required.
Certifications
One of the following certifications is required:
-
Certified Professional Coder (CPC) – AAPC
-
Certified Coding Specialist – Physician-based (CCS-P) – AHIMA
-
Equivalent credential approved by AAPC or AHIMA
Required Skills
-
Minimum 4+ years of medical coding experience
-
Experience in auditing Profee surgery settings.
-
Knowledge of multiple specialty coding as outlined.
Preferred Experience
-
Prior experience working as Quality Analyst (QA) or Coding Audit roles
Familiarity with coding audit tools, encoder software, and EHR systems
Work Location : Hyderabad
Interested Contact : Viraja HR (8121012268)
Regards
Talent Acquisition Team
Eclat Health Solutions India Pvt Ltd.
