Medical Coding Quality Analyst

Quality Control Analyst (QCA) – Medical Coding

4–5 years in Medical Coding (with auditing/QC exposure preferred)

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.

• →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

• 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

• Graduate in Life Sciences / Medical / Paramedical field
• Certifications such as CPC / CCS / CIC preferred

• Audit accuracy (%)
• Error detection rate
• Reduction in repeat errors
• Adherence to SLA/TAT
• Team quality improvement metrics