Coding Quality Analyst

Hospital Medical Coding Quality Assurance Location: Makati Company:

Job Title: Medical Coding Quality Assurance (QA) Specialist Location: Makati City, Philippines (On-site): (based Full-time .About Company healthcare coding and revenue cycle management solutions. They are committed to accurate, compliant, and high-quality coding practices to support hospital operations and patient care. 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.

Qualifications. 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

Excellent analytical, organizational, and communication skills. Ability to interpret complex medical documentation and apply coding guidelines accurately. email provided.

Job Type: Full-time Work Location: Onsite