Job Summary

The Quality Analyst is responsible for auditing coded medical records with a primary focus on Evaluation and Management (E/M) services and the procedures performed in the office settings to ensure coding accuracy, compliance with regulatory standards, and adherence to payer guidelines.

The role involves reviewing Inpatient (IP) and Outpatient (OP) medical records across multiple specialties and validating correct code assignment using the Current Procedural Terminology (CPT), ICD-10-CM, Modifiers and HCPCS Level II code sets.

The Quality Analyst will identify coding discrepancies, provide feedback and training to coding teams, monitor quality metrics, and ensure compliance with payer policies and regulatory guidelines.

Key Responsibilities

Expertise: In-depth knowledge of E&M coding guidelines and the procedures performed in the office settings.

In-depth knowledge in multi-specialty coding such as Orthopedics, Family practice, OBGYN, Neurology, Oncology etc.

Perform detailed quality audits of Evaluation & Management (E/M) charts.

Review Inpatient and Outpatient coding charts for accuracy, completeness, and compliance.

Validate the correct assignment of CPT, ICD-10-CM, HCPCS Level II codes & Modifiers.

Ensure proper application of E/M documentation requirements and coding guidelines.

Identify coding errors, documentation gaps, and compliance risks.

Monitor coding quality benchmarks and maintain audit accuracy standards.

Provide feedback, coaching, and training to coding teams based on audit findings.

Support coding accuracy improvement initiatives and process optimization.

Stay updated with coding guideline updates, payer policies, and regulatory changes.

Certifications

One of the following certifications is required:

Certified Professional Coder (CPC) – AAPC

Certified Coding Specialist – Physician-based (CCS-P) – AHIMA

Equivalent credential approved by AAPC or AHIMA

Required Skills

Minimum 5 + years of medical coding experience

Strong expertise in overall Evaluation & Management (E/M) coding.

Experience in auditing Inpatient and Outpatient coding in office settings.

Knowledge of multiple specialty coding as outlined.

Preferred Experience

Prior experience working as Quality Analyst (QA) or Coding Audit roles

Familiarity with coding audit tools, encoder software, and EHR systems