Quality Analyst - IP DRG Coding

Guidehouse; Chennai District; On-site; INR 700,000 - 1,000,000; Full time

Benefits offered by this job

Competitive compensation

Flexible benefits package

Supportive workplace environment

Job summary

A leading consulting firm in Chennai seeks a qualified candidate for Quality Assurance in Coding. The role involves directing QA production, reviewing medical records for coding accuracy, and ensuring compliance with guidelines. Candidates must have a minimum of 3 years in IP DRG coding and relevant certifications. The company offers competitive compensation and a comprehensive benefits package, fostering a diverse work environment.

Qualifications

• Minimum 3+ years of experience in IP DRG coding specialty, and a minimum 1 year of experience in IP auditing.
• Experience with ICD-10-PCS coding systems, ensuring accuracy and compliance.

Responsibilities

• Plans, monitors, directs, and evaluates QA production daily.
• Review medical record documentation for accuracy in code assignment.
• Meets agreed sampling targets and accuracy.
• Documents QA data and records findings in the QA system.

Skills

ICD-10-PCS coding systems

Good communication

Analytical skills

Education

Graduate

Mandatory certifications (CIC, CCS, CPC)

Tools

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Job description

Job Family

Coding Quality IP (India)

Travel Required

None

Clearance Required

None

What You Will Do

• Plans, monitors, directs, and evaluates QA production daily. 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 and schedules to return to established schedules at the earliest possible time. This is done closely with each quality specialist to ensure the needs are met and satisfy the client’s requirements.
• Ensures that the QA communicates a valid, workable schedule for their 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.
• Review medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 coding conventions. Sequence the diagnosis and procedures using coding guidelines. When applicable, ensures MS-DRG/APC assignment is accurate. Abstracts and compiles data from medical records for appropriate optimal/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 reported to the client, identify risk areas, and develop training and education programs. Also involves guidance and mentorship of coders.
• Helps to ensure that continuing education is planned, scheduled, and completed for all coding/QA teams through 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.
• Project Launch – Active involvement in project launch sessions 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, etc.).

What You Will Need

• Minimum 3+ years of experience in IP DRG coding specialty, and a minimum 1 year of experience in IP auditing.
• Mandatory certifications such as CIC, CCS, CPC.
• Must be a Graduate.
• Good communication and analytical skills are required.
• Experience with ICD‑10‑PCS coding systems, ensuring accuracy and compliance with all regulatory and reimbursement requirements.
• Day‑to‑day tasks include reviewing patient records, assigning appropriate DRGs, collaborating with clinical staff to gather accurate documentation, and participating in quality improvement initiatives.

What Would Be Nice To Have

• Experience with Microsoft Excel, Word, and PowerPoint.

What We Offer

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.

About Guidehouse

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.

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