Medical Coding Quality Analyst

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