Quality Control Analyst

Job Title

Quality Control Analyst (QCA) – Medical Coding

Experience

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

Job Summary

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.

Key Responsibilities

• 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

Required Skills & Competencies

• 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

Qualifications

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

Key Performance Indicators (KPIs)

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