Quality Analyst - Facility IP DRG

Guidehouse; Chennai District; On-site; INR 500,000 - 800,000; Full time

Benefits offered by this job

Comprehensive total rewards package

Flexible benefits package

Job summary

Guidehouse is seeking experienced medical coders in Chennai, India, to oversee quality assurance in coding processes. You will coordinate teams and ensure compliance with coding standards and guidelines.

The ideal candidate will have over 5 years of experience, with accredited coding certifications. This role also includes responsibilities such as mentoring coders and implementing training programs. A competitive compensation and flexible benefits package is offered.

Qualifications

• Accredited medical coders with at least 3+ years of experience.
• Experience level: 5+ years in coding.

Responsibilities

• Plans, monitors, directs and evaluates QA production daily.
• Ensures accurate medical record documentation and coding.
• Answers queries from quality staff and meets agreed sampling targets.

Skills

IP DRG

Accredited medical coder

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Education

Accredited medical coders (CCA, CCS, CPC, CPC-H)

Job description

Responsibilities

• Plans, monitors, directs and evaluates QA production on a daily basis. Ensures that daily schedules are met and communicates with the Director and Coding Operations if situations occur that hinder meeting deadlines. If system issues or other emergencies delay QA, implements measures or schedules to return to established schedules at the earliest possible time. This should be done closely with each quality specialist to ensure that needs are met and that client requirements are satisfied.
• Ensures that the QA communicates a valid, workable schedule for his or her client each week. Accurate, sensible, and on‑time. If this doesn’t happen properly, it is the responsibility of the Lead QA Specialist to make it happen promptly.
• Reviews medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD‑9‑CM and CPT‑4 coding conventions. Sequences the diagnosis and procedures using coding guidelines. When applicable, ensures MS‑DRG/APC assignment is accurate. Abstracts and compiles data from medical records for optimal or complaint reimbursement for hospital and/or professional charges. This involves reviewing code assignments that are not straightforward or the documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Answers queries from the quality staff on a day‑to‑day basis and escalates to the Director of Coding as necessary.
• Meets agreed sampling targets and accuracy.
• Keeps abreast of coding guidelines and reimbursement reporting requirements.
• Documents QA data on teams of QA/coders and records findings in the QA system (Guide Audit), which will be used for reporting to the client, identifying risk areas, development of training and education programs, and development/implementation of standardization within the organization. This also involves guidance and mentorship of coders.
• Helps ensure that continuing education is planned, scheduled and completed for all coding/QA teams through the coordination of the US.
• Coordinates scheduled quality meetings with the QA and production staff.
• Brings identified concerns to Guidehouse’s coding compliance management for discussion.
• Participates in project launch sessions along with team leaders to understand the coding process.
• Has a rotational arrangement and is flexible to work with any given team as assigned.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques to effectively apply ICD‑9‑CM and CPT‑4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Assists with research and development and presentation of continuing education programs on areas of specialization.
• Assists with special projects as required (e.g., focused audits, client launches).

Qualifications

• Accredited medical coders (CCA, CCS, CPC, CPC‑H) with at least 3+ years’ experience.
• Key skills: IP DRG.
• Experience level: 5+ years.

Nice to Have Skills

• Proficiency with Microsoft Excel, Word and PowerPoint.

Benefits

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

EEO Statement

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance, including the Fair Chance Ordinance of Los Angeles and San Francisco.