E/M Quality Analysis

Advantum Health; Hyderabad; On-site; INR 600,000 - 900,000; Full time

Job summary

Advantum Health is seeking a Coding Auditor to perform retrospective and prospective audits of coded medical records, ensuring accuracy and compliance with ICD-10-CM, CPT, and payer requirements. You will identify gaps, provide actionable feedback, and develop training based on audit findings and regulatory updates.

In this role, you will collaborate with CDI, revenue cycle, and clinical leadership to ensure proper capture of clinical complexity and reimbursement.

Responsibilities

• Conduct retrospective and prospective audits of coded records to evaluate accuracy, consistency, and compliance with coding guidelines (ICD-10-CM, CPT, E/M) and payer requirements
• Identify documentation and coding gaps, trends, and opportunities for improvement across service lines, focusing on high-risk areas like E/M, ED, and specialty coding
• Provide clear, actionable feedback to coders and providers, including audit results and education on best practices
• Develop and deliver coding and documentation education based on audit findings, regulatory updates, and organizational priorities
• Collaborate with CDI, revenue cycle, compliance, and clinical leadership to ensure accurate capture of clinical complexity and appropriate reimbursement
• Support internal and external audit activities, including payer audits and regulatory reviews
• Track and report key performance metrics, including coding accuracy rates, error trends, and audit outcomes
• Assist in developing and maintaining coding policies, procedures, and training materials
• Serve as a subject matter expert for coding inquiries, offering guidance on complex cases
• Stay current on regulatory changes and industry best practices and disseminate relevant information timely

Job description

Role & responsibilities

• Conduct retrospective and prospective audits of coded records to evaluate accuracy, consistency, and compliance with applicable coding guidelines (e.g., ICD-10-CM, CPT, E/M guidelines, and payer-specific requirements)
• Identify documentation and coding gaps, trends, and opportunities for improvement across service lines, with a focus on high-risk areas such as E/M, ED, and specialty coding
• Provide clear, actionable feedback to coders and providers, including detailed audit results and education on best practices
• Develop and deliver coding and documentation education based on audit findings, regulatory updates, and organizational priorities
• Collaborate with CDI, revenue cycle, compliance, and clinical leadership to ensure accurate capture of clinical complexity and appropriate reimbursement
• Support internal and external audit activities, including payer audits, regulatory reviews, and compliance initiatives
• Track and report key performance metrics, including coding accuracy rates, error trends, and audit outcomes
• Assist in the development and maintenance of coding policies, procedures, and training materials
• Serve as a subject matter expert for coding-related inquiries, providing guidance on complex cases and documentation scenarios
• Stay current on regulatory changes, coding updates, and industry best practices, and ensure timely dissemination of relevant information.