Quality Analyst - Inpatient Medical Coding

Med-Metrix; Philippines; Remote; PHP 446,000 - 781,000; Full time

Benefits offered by this job

Fulltime Permanent Remote

8-Hour Shifts, Fixed Weekends Off

Day 1 HMO with 2 of your dependents""s

Group Life Insurance

Medical cash allowance

Rice allowance

Clothing allowance

Holiday Gift

Bereavement assistance

Paid time off

Training and staff development

Employee engagement activities

Opportunities for internal mobility

Job summary

Med-Metrix is seeking a Quality Analyst, Inpatient Coding to join our remote team in the Philippines. You will design and implement quality coding review programs, assess CPT/ICD-10-CM/HCPCS accuracy, and communicate findings to coding management. The role emphasizes HIPAA compliance and risk assessment.

You'll lead a team to meet quality targets, collaborate across departments, and drive continuous improvement while working from home with day shifts. Training and career development are provided.

Qualifications

• Graduate of any Medical or Allied Medical course or has equivalent work experience.
• Hold AAPC and/or AHIMA certification. CPMA is an advantage.
• At least 3 years of IP DRG Coding
• Proficient with E/M and CPT Procedure coding.
• Minimum of six (6) months experience with exceptional performance in chosen area of quality management Medical Coding – demonstrated HIPAA knowledge required
• Ability to work in a team fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures and unexpected workloads and stresses.
• Possess strong verbal, written communication, interpersonal skills and analytical skills
• Willingness and flexibility to work extended hours.
• Assertive self-starter who can work independently, yet function in a team environment
• Ability to plan well and prioritize work and maintain calmness under pressure.
• An understanding and strict adherence to all HIPAA regulations

Responsibilities

• Sets team direction, resolves problems and provides guidance to members of own team
• Lead, coach, recognize and develop a team of Employees in all aspects of the job to meet objectives and maintain company culture, polices, goals and procedures
• Administer the Quality Assessment process to ensure all quality standards/targets can be met
• Daily management of all operational processes to ensure that quality, efficiency and productivity standards/targets are met
• Acts as client contact for day-to-day operational issues and staff assignments. Escalate any client concerns immediately to Medical Coding Manager or General Manager.
• Review and analyze reports, records, and data to meet and exceed client and company objectives.
• Collaborate with all workgroups to resolve issues that impact internal and external customers.
• Rewarding and disciplining employees; addressing complaints and resolving problems
• Look constantly for development as well as continuous improvement for the entire team.
• Ensure that the employees follow their schedules properly as designed.
• Strive for new ways to increase the opportunities of efficient, accurate work assignments.
• Handle complaints, questions, and queries as necessary.
• Documenting general reports on each team member's performance and targets as well as ensuring that they exceed the targets.
• Monitor systems to ensure optimal performance.
• Disseminates changes in guidelines and rules; monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement to assure compliance.
• Foster an environment of teamwork and service excellence within the department.
• Participate in performance improvement activities.
• Assist in the establishment of, implementation and maintenance of a formalized review process to ensure compliance with contractual agreements regarding accuracy rates.
• Assist in the creation, monitoring and standardization of company policies and procedures to monitor the success of the data quality management plan, review our and our clients areas of risk, investigate identified issues, report data analyses and take appropriate steps to correct any violations. Make recommendations to ensure the highest compliance rate with the Med-Metrix quality management plan.
• Participate in conference calls/meetings with management and staff to ensure all performance and training recommendations are addressed and improvement suggestions are implemented.
• Assist in new hire training classes, transition periods and refresher trainings as needed.
• Knowledge of, understanding of, and compliance with all Med-Metrix policies and procedures.
• Provide feedback to management concerning possible problems or areas of needed improvement.
• Use, protect and disclose patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Skills

IP DRG Coding

E/M CPT coding

HIPAA compliance

Analytical skills

Verbal & written communication

Team collaboration

Flexibility to extended hours

Education

Medical/Allied Medical degree

AAPC/AHIMA certification

CPMA (advantage)

Job description

Join our dynamic team and make a meaningful impact in the healthcare industry. You'll play a pivotal role in ensuring accurate claims processing while advancing your career in a supportive and innovative environment. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of helping others every day. Take the next step in your career with Med-Metrix!

Experience these exceptional benefits when you join Med-Metrix!

• Fulltime Permanent Remote
• 8-Hour Shifts, Fixed Weekends Off
• Day 1 HMO with 2 of your dependents covered for FREE
• Group Life Insurance
• Medical Cash Allowance
• Rice Allowance
• Clothing Allowance
• Holiday Gift
• Bereavement Assistance
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

Job Purpose

The Quality Analyst, Inpatient Coding collaborates with internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. The Quality Analyst, Coding will assess and review the overall quality of coding on accounts completed by Medical Coders. The Quality Analyst, Coding, ensures adherence to workflows and ethical coding. The position requires advanced knowledge of professional coding (CPT, ICD-10-CM and HCPCS).

The Quality Analyst, Inpatient Coding is responsible for designing and implementing quality coding review programs and communicating review findings and recommendations to coding management. The position obtains statistics and the information necessary to assess risk for all areas of coding.

Duties and Responsibilities

• Sets team direction, resolves problems and provides guidance to members of own team
• Lead, coach, recognize and develop a team of Employees in all aspects of the job to meet objectives and maintain company culture, polices, goals and procedures
• Administer the Quality Assessment process to ensure all quality standards/targets can be met
• Daily management of all operational processes to ensure that quality, efficiency and productivity standards/targets are met
• Acts as client contact for day-to-day operational issues and staff assignments. Escalate any client concerns immediately to Medical Coding Manager or General Manager.
• Review and analyze reports, records, and data to meet and exceed client and company objectives.
• Collaborate with all workgroups to resolve issues that impact internal and external customers.
• Rewarding and disciplining employees; addressing complaints and resolving problems
• Look constantly for development as well as continuous improvement for the entire team.
• Ensure that the employees follow their schedules properly as designed.
• Strive for new ways to increase the opportunities of efficient, accurate work assignments.
• Handle complaints, questions, and queries as necessary.
• Documenting general reports on each team member's performance and targets as well as ensuring that they exceed the targets.
• Monitor systems to ensure optimal performance.
• Disseminates changes in guidelines and rules; monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement to assure compliance.
• Foster an environment of teamwork and service excellence within the department.
• Participate in performance improvement activities.
• Assist in the establishment of, implementation and maintenance of a formalized review process to ensure compliance with contractual agreements regarding accuracy rates.
• Assist in the creation, monitoring and standardization of company policies and procedures to monitor the success of the data quality management plan, review our and our clients areas of risk, investigate identified issues, report data analyses and take appropriate steps to correct any violations. Make recommendations to ensure the highest compliance rate with the Med-Metrix quality management plan.
• Participate in conference calls/meetings with management and staff to ensure all performance and training recommendations are addressed and improvement suggestions are implemented.
• Assist in new hire training classes, transition periods and refresher trainings as needed.
• Knowledge of, understanding of, and compliance with all Med-Metrix policies and procedures.
• Provide feedback to management concerning possible problems or areas of needed improvement.
• Use, protect and disclose patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Qualifications

• Graduate of any Medical or Allied Medical course or has equivalent work experience.
• Hold AAPC and/or AHIMA certification. CPMA is an advantage.
• At least 3 years of IP DRG Coding
• Proficient with E/M and CPT Procedure coding.
• Minimum of six (6) months experience with exceptional performance in chosen area of quality management Medical Coding – demonstrated HIPAA knowledge required
• Ability to work in a team fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures and unexpected workloads and stresses.
• Possess strong verbal, written communication, interpersonal skills and analytical skills
• Willingness and flexibility to work extended hours.
• Assertive self-starter who can work independently, yet function in a team environment
• Ability to plan well and prioritize work and maintain calmness under pressure.
• An understanding and strict adherence to all HIPAA regulations

Working Conditions

• Work Set-Up: Work From Home
• Work Schedule: Dayshift
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.