Medical Coding Quality Assurance QA Specialist

Pay: ₱40,000.00 - ₱50,000.00 per month

Job description:.

Job Summary

The QA Specialist ensures accuracy, compliance, and integrity of hospital medical coding for inpatient and outpatient records. The role involves auditing coded encounters, validating DRG/APC assignments, and supporting coding teams through education and feedback.

Key Responsibilities

• Conduct retrospective and concurrent audits of hospital-coded records (inpatient, outpatient, day surgery).
• Validate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes for accuracy and compliance with official guidelines.
• Review DRG/APC assignments and sequencing according to AHA Coding Clinic and CMS regulations.
• Ensure adherence to hospital policies, payer requirements, and regulatory standards. Maintain audit logs, scorecards, and reports.
• Provide detailed feedback to coders based on audit findings. Recommend educational topics and assist in coder training programs.
• Collaborate with Clinical Documentation Integrity (CDI) teams to resolve mismatched DRGs and improve documentation.
• Participate in denial management and appeal processes related to coding.
• Identify trends, risks, and recommend process improvements. Stay updated on coding guidelines and reimbursement changes.
  
  

• Minimum 3–5 years of hospital coding experience; 1–2 years in QA or auditing preferred.
• Certifications: CCS, CIC, CPC, CPMA, or equivalent coding certification required.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, DRG/APC assignment.
• Experience with hospital-based coding audits, denial management, and EMR systems (e.g., 3M, Optum, Meditech).
• Excellent analytical, organizational, and communication skills.
• Ability to interpret complex medical documentation and apply coding guidelines accurately.