Quality ED profee

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

Job summary

Ascent Business Solutions in Hyderabad, India seeks a quality auditor to review Emergency Department medical records coding. You will assess ICD-10-CM, CPT, and HCPCS codes for accuracy and ensure documentation supports MDM-based E/M determinations.

You will identify discrepancies, provide feedback, track performance metrics, and collaborate with clients to calibrate processes. The role emphasizes adherence to coding guidelines, SOPs, and regulatory standards.

Responsibilities

• Conduct quality audits of Emergency Department medical records coded by ED coders.
• Validate ICD-10-CM, CPT, and HCPCS codes for accuracy where applicable.
• Review E/M level selection based on MDM, documentation, and coding guidelines.
• Verify principal/secondary diagnoses, sequencing, modifiers, and coding elements.
• Ensure compliance with coding guidelines, payer rules, SOPs, and regulatory standards.
• Identify coding discrepancies, undercoding, overcoding, missed diagnoses, and related issues.
• Provide timely, constructive feedback to coders with rationale for errors.
• Track audit scores, error trends, coder performance, and recurring quality issues.
• Perform root cause analysis and suggest corrective and preventive actions.
• Support coder education, refresher training, calibration sessions, and process updates.
• Participate in internal/client quality calibration meetings for consistency.
• Maintain audit docs, quality reports, and productivity records on schedule.
• Meet 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.