Quality Auditing Analyst

Job Title: Hospital Medical Coding Quality Assurance (QA) Specialist

Location: Manila

Job Type: Full-time

Experience: Minimum 35 years hospital coding experience,

12 years in QA/auditing preferred.

Job Summary

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

Key Responsibilities

Audit & Review:

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 claims per AHA Coding Clinic and CMS regulations.

Compliance & Documentation

Ensure adherence to hospital policies, payer requirements, and regulatory standards.

Maintain audit logs, scorecards, and prepare reports for management.

Education & Feedback

Provide detailed feedback to coders based on audit findings.

Recommend educational topics and assist in coder training programs.

Collaboration

Work with Clinical Documentation Integrity (CDI) teams to resolve mismatched DRGs and improve documentation.

Participate in denial management and appeal processes for coding-related issues.

Continuous Improvement

Identify trends, risks, and recommend process improvements.

Stay updated on coding guidelines and reimbursement changes.

Certifications

CCS, CIC, CPC, CPMA or equivalent coding certification required.

Skills

Experience in hospital-based coding audits and denial management.

Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, DRG/APC assignment.

Familiarity with EMR systems and coding tools (e.g., 3M, Optum, Meditech).

Excellent analytical and communication skills.

Ability to interpret complex medical documentation and apply coding guidelines accurately.