QA - HIM Services

CorroHealth Infotech Private Limited; Dadri; On-site; INR 500,000 - 700,000; Full time

Job summary

CorroHealth Infotech Private Limited is looking for a Medical Coding Edits and Denial Quality Analyst. This position focuses on analyzing, reviewing, and resolving coding-related claim edits and insurance denials, ensuring compliance with payer regulations.

The ideal candidate will have significant experience in coding, exceptional analytical skills, and the ability to educate medical coders. A degree in Health Information Management or related field and coding certification are required. The role can be performed remotely.

Qualifications

• Expertise in coding standards and modification usage.
• 3–5 years in medical coding with a focus on denials.
• Valid coding certification is required.

Responsibilities

• Analyze coding-related claim edits and denials.
• Collaborate with teams to appeal denials.
• Develop denial dashboards and present reports.

Skills

Expert knowledge of CPT, ICD‑10‑CM/PCS, HCPCS Level II

Analytical thinking

Communication skills

Organizational skills

Education

Associate’s or Bachelor’s degree in Health Information Management

Tools

Epic

Excel

Job description

Job Summary

The Medical Coding Edits and Denial Quality Analyst is responsible for analyzing, reviewing, and resolving coding-related claim edits and insurance denials. This role involves performing root‑cause analysis on denied claims, identifying coding trends that lead to financial loss, and providing feedback to the coding and clinical teams. The goal is to ensure clean claim submission, reduce denial rates, and comply with payer‑specific regulations.

Key Responsibilities

1. Denial Management & Root Cause Analysis
   • Analyze daily claim denials related to coding (ICD‑10‑CM, CPT, HCPCS, and Modifiers).
   • Perform deep dive root‑cause analysis to determine why claims are rejected.
   • Collaborate with billing and follow‑up teams to appeal denials and recover lost revenue.
2. Coding Edit Resolution
   • Review and clear pre‑billing edits (e.g., NCCI, MUE, LCD/NCD, and internal scrubber edits).
   • Correct coding errors in the EHR system before claims are sent to payers.
   • Identify recurring system edits that require logic updates within the billing software.
3. Quality Assurance & Auditing
   • Perform prospective and retrospective coding quality audits to ensure accuracy and compliance.
   • Monitor the accuracy of DRG (Inpatient) or APC (Outpatient) assignments.
   • Validate that documentation in the medical record supports the codes billed.
4. Reporting and Data Analytics
   • Develop and maintain denial dashboards to track trends by payer, provider, or specialty.
   • Present monthly reports to leadership regarding denial rates, recovery amounts, and areas for improvement.
   • Use Excel or BI tools to manipulate large sets of claims data.
5. Provider & Staff Education
   • Provide feedback and training to medical coders regarding updated coding guidelines.
   • Collaborate with physicians and clinical staff to improve documentation specificity (Clinical Documentation Improvement).
   • Develop educational materials to prevent future denials.
6. Compliance & Policy Maintenance
   • Stay current on annual ICD‑10 and CPT code changes, OIG work plans, and payer bulletins.
   • Ensure all coding activities adhere to HIPAA regulations and CMS guidelines.

Required Skills & Qualifications

• Expert knowledge of CPT, ICD‑10‑CM/PCS, HCPCS Level II, and modifier usage.
• Deep understanding of NCCI, MUE and LCD/NCD edits.
• Analytical thinking to spot patterns and translate data into actionable improvements.
• Advanced experience with EHR systems (Epic, Cerner, Meditech) and revenue cycle software (Waystar, Availity, nThrive).
• Excellent communication skills; ability to explain complex coding/billing concepts to non‑coding staff and physicians.
• Strong organizational and confidentiality management skills.

Education & Experience Requirements

• Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field.
• Minimum 3–5 years of medical coding experience, focusing on denials, audits, or revenue cycle analysis.
• Valid coding certification (CPC, COC, CRC, CPCP from AAPC; CCS, CCSP, CCA from AHIMA) or related certification.
• Proficient computer skills; comfortable with Excel, pivot tables, and VLOOKUPs.

Physical Demands & Work Environment

Remote or office‑based environment. Extensive computer use and prolonged sitting. Ability to manage high volumes of data with extreme attention to detail. May be required to lift up to 20 lbs. Work may involve times of increased activity and multiple deadlines.