We are looking for a detail-oriented Quality Control for Coding Specialist to ensure the accuracy, compliance, and consistency of medical coding and billing practices. This role plays a vital part in maintaining the integrity of health data and optimizing the revenue cycle by implementing internal audits, reviews, feedback processes, and continuous improvement initiatives. You'll be part of a team committed to Leadership, Excellence, Innovation, and a culture of Agility, Accountability, Collaboration, and Customer Centricity.
Key Responsibilities
Delighting Our Customers & Stakeholders
- Ensure coding accuracy using ICD-10, CPT, and applicable guidelines
- Perform internal audits and peer reviews
- Validate clinical documentation supports coded entries
- Enforce compliance with HIPAA and payer requirements
Growing Our Business
- Reduce coding-related denials and rejections
- Support revenue cycle optimization through timely audits
- Recommend process enhancements and tools for better accuracy
- Contribute insights to client engagement and support activities
Improving the Way We Work
- Use audit tools and QC platforms to automate checks
- Maintain and update audit protocols and workflows
- Analyze data trends to address recurring issues
- Collaborate across departments for process alignment
Developing Myself and Others
- Provide feedback and coaching to coding team members
- Lead or join training sessions on compliance and coding standards
- Stay updated on industry guidelines and certifications
- Promote a quality-first, learning-driven culture
Key Metrics
- 95% coding accuracy rate
- 90% clean claims rate
- 5% documentation-related coding error rate
- 20% YOY reduction in coding-related denials
- 90% adherence to QC protocols and audit schedules
- 2 professional development activities per year
Qualifications
- Degree in Health Information Management, Nursing, or related field
- Certified Professional Coder (CPC), CCS, or equivalent
- 23 years experience in medical coding and quality control
- Knowledge of ICD-10, CPT, HCPCS, CMS, and payer-specific guidelines
- Proficiency in medical coding software and audit platforms
- Strong analytical, communication, and collaboration skills
