Quality Auditing Analyst

ASP-RCM Solutions; Metro Manila; Presencial; PHP 600 000 - 900 000; Tempo integral

Resumo da oferta

ASP-RCM Solutions in Manila is seeking a Hospital Medical Coding Quality Assurance Specialist to ensure accuracy and compliance across inpatient and outpatient records. The role focuses on auditing coded encounters, validating DRG/APC assignments, and supporting coding teams with education and feedback.

You will collaborate with CDI teams, participate in denial management, and stay current with coding guidelines and reimbursement changes.

Qualificações

• Minimum 35 years hospital coding experience.
• Certification required: CCS, CIC, CPC, CPMA or equivalent.
• Experience with audits of inpatient and outpatient records and denial management.

Responsabilidades

• Audit & Review: retrospective and concurrent audits of inpatient, outpatient, and day-surgery records.
• Validate ICD-10-CM/ICD-10-PCS, CPT, and HCPCS codes for accuracy and compliance with official guidelines.
• Review DRG/APC assignments and sequencing per AHA Coding Clinic and CMS regulations.
• Compliance & Documentation: ensure adherence to hospital policies, payer requirements, and regulatory standards; maintain audit logs, scorecards, and prepare reports for management.
• Education & Feedback: provide detailed feedback to coders based on audit findings; recommend educational topics and assist in coder training programs.
• Collaboration: work with CDI teams to resolve mismatched DRGs and improve documentation; participate in denial management and appeal processes for coding-related issues.
• Continuous Improvement: identify trends, risks, and recommend process improvements; stay updated on coding guidelines and reimbursement changes.
• Certifications: CCS, CIC, CPC, CPMA or equivalent coding certification required.
• Skills: experience in hospital-based coding audits and denial management; strong knowledge of ICD-10-CM/PCS, CPT, DRG/APC assignment; familiarity with EMR systems and coding tools (3M, Optum, Meditech); excellent analytical and communication skills; ability to interpret complex medical documentation and apply coding guidelines accurately.

Conhecimentos

ICD-10-CM/ICD-10-PCS expertise

CPT/HCPCS coding knowledge

DRG/APC assignment knowledge

Auditing and denial management

EMR coding systems familiarity

Analytical communication skills

Ferramentas

3M coding software

Optum

Meditech

Descrição da oferta de emprego

Job Title: Hospital Medical Coding Quality Assurance (QA) Specialist

Location: Manila

Job Type: Full-time

Experience: Minimum 35 years hospital coding experience, 12 years in QA/auditing preferred.

Job Summary

The QA Specialist ensures accuracy, compliance, and integrity of hospital medical coding for inpatient and outpatient records. This role involves auditing coded encounters, validating DRG/APC assignments, and supporting coding teams through education and feedback.

Key Responsibilities

• Audit & Review: Conduct retrospective and concurrent audits of hospital-coded records (inpatient, outpatient, day surgery).
• Validate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes for accuracy and compliance with official guidelines.
• Review DRG/APC assignments and sequencing claims per AHA Coding Clinic and CMS regulations.
• Compliance & Documentation: Ensure adherence to hospital policies, payer requirements, and regulatory standards; maintain audit logs, scorecards, and prepare reports for management.
• Education & Feedback: Provide detailed feedback to coders based on audit findings; recommend educational topics and assist in coder training programs.
• Collaboration: Work with Clinical Documentation Integrity (CDI) teams to resolve mismatched DRGs and improve documentation; participate in denial management and appeal processes for coding-related issues.
• Continuous Improvement: Identify trends, risks, and recommend process improvements; stay updated on coding guidelines and reimbursement changes.
• Certifications: CCS, CIC, CPC, CPMA or equivalent coding certification required.
• Skills: Experience in hospital-based coding audits and denial management; strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, DRG/APC assignment; familiarity with EMR systems and coding tools (e.g., 3M, Optum, Meditech); excellent analytical and communication skills; ability to interpret complex medical documentation and apply coding guidelines accurately.