Pay: 40,000.00 - 50,000.00 per month
Job description:.
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 35 years of hospital coding experience; 12 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 (e.g., 3M, Optum, Meditech).
- Excellent analytical, organizational, and communication skills.
- Ability to interpret complex medical documentation and apply coding guidelines accurately.
Job Type: Full-time
Work Location: In person
