Quality Auditor - ED Profee

Ascent Business Solutions; Hyderabad; On-site; INR 600,000 - 900,000; Full time

Job summary

Ascent Business Solutions in Hyderabad is seeking a quality auditor to review Emergency Department medical records coding. You will audit ED coder work, validate ICD-10-CM, CPT, and HCPCS codes, and assess E/M levels based on MDM and guidelines.

You will verify principal and secondary diagnoses, modifiers, and sequencing, ensuring compliance with coding guidelines, SOPs, and regulatory standards. You will provide feedback, track trends, and support education and calibration activities.

Responsibilities

• Conduct quality audits of Emergency Department medical records coded by ED coders.
• Validate the accuracy of ICD-10-CM diagnosis codes, CPT codes, and HCPCS codes, wherever applicable.
• Review E/M level selection based on medical decision-making (MDM), documentation, and applicable coding guidelines.
• Verify the accuracy of principal and secondary diagnoses, sequencing, modifiers, and other coding elements, as applicable.
• Ensure compliance with official coding guidelines, payer requirements, client-specific SOPs, and regulatory standards.
• Identify coding discrepancies, undercoding, overcoding, missed diagnoses, and documentation-related issues.
• Provide timely, constructive feedback to coders and explain the rationale behind identified errors.
• Track audit scores, error trends, coder performance, and recurring quality issues.
• Conduct root cause analysis and recommend corrective and preventive actions to improve coding accuracy.
• Support coder education, refresher training, calibration sessions, and process updates.
• Participate in internal and client quality calibration meetings to ensure consistency in audit outcomes.
• Maintain audit documentation, quality reports, and productivity records within defined timelines.
• Meet established quality, productivity, turnaround time, and compliance targets.

Job description

• Conduct quality audits of Emergency Department medical records coded by ED coders.
• Validate the accuracy of ICD-10-CM diagnosis codes, CPT codes, and HCPCS codes, wherever applicable.
• Review E/M level selection based on medical decision-making (MDM), documentation, and applicable coding guidelines.
• Verify the accuracy of principal and secondary diagnoses, sequencing, modifiers, and other coding elements, as applicable.
• Ensure compliance with official coding guidelines, payer requirements, client-specific SOPs, and regulatory standards.
• Identify coding discrepancies, undercoding, overcoding, missed diagnoses, and documentation-related issues.
• Provide timely, constructive feedback to coders and explain the rationale behind identified errors.
• Track audit scores, error trends, coder performance, and recurring quality issues.
• Conduct root cause analysis and recommend corrective and preventive actions to improve coding accuracy.
• Support coder education, refresher training, calibration sessions, and process updates.
• Participate in internal and client quality calibration meetings to ensure consistency in audit outcomes.
• Maintain audit documentation, quality reports, and productivity records within defined timelines.
• Meet established quality, productivity, turnaround time, and compliance targets.