Designation-Quality Control Analyst – Medical Coding

Role Type-Medical Coding Auditor cum SME

Specialties-General Surgery Coding (CPT 10000–69999 / 1-series to 6-series)

Reports To-Head of Coding Integrity & Quality

Experience5+ years hands-on general surgery coding & auditing across CPT 1-series to 6- series

Location-Bangalore (Bengaluru), Karnataka

Work Mode-Work From Office – mandatory

Shift-Mid shift – 12:00 PM to 9:00 PM IST

Employment:Full-time

We are seeking an experienced Medical Coding Auditor cum SME with strong general surgery coding expertise to ensure coding accuracy, compliance, and quality across AI-coded and human-coded surgical charts. The role combines hands-on chart auditing with subject-matter leadership — validating CPT, ICD-10-CM, HCPCS and modifier assignment, delivering structured feedback to coders, and partnering with SME and data science teams to drive continuous improvement of AI-assisted surgical coding. The ideal candidate has practical coding experience across the full general surgery CPT range (1-series through 6-series), a strong grasp of surgical guidelines (CMS / AMA / NCCI), and the ability to

translate coding expertise into actionable inputs for both operations and AI model development.

Key Responsibilities

Domain

Key Activities

Surgical Coding Audits

- Audit AI-coded and human-coded surgical charts across the general surgery CPT range
- Validate CPT, ICD-10-CM, HCPCS and modifier accuracy
- Verify operative-note support for code selection and units

Error Identification & Analysis

- Identify missed codes, incorrect coding and compliance risks




- Document errors with explicit CPT / ICD-10 / modifier rationale and guideline references
- Flag recurring error patterns for team-level education

Compliance Monitoring

- Ensure adherence to CMS, AMA and AHA guidelines and client-specific SOPs
- Apply NCCI edits, global surgery rules and modifier logic correctly
- Apply updated guideline and coding changes to daily audit practice

Feedback & Education

- Deliver structured, case-level feedback to coders
- Conduct feedback discussions and support continuous learning Identify training needs and contribute to coder development

Required Qualifications & Skills

● Minimum 5+ years of hands-on general surgery coding and auditing experience across CPT 1- series to 6-series.

● Active coding certification – CPC, COC, CCS, CGSC or equivalent (AAPC / AHIMA).

● In-depth knowledge of CPT, ICD-10-CM, HCPCS, surgical modifiers and NCCI / global surgery rules.

● Sound understanding of CMS, AMA and AHA coding and compliance guidelines.

● Strong operative-note interpretation skills and ability to validate code selection against documentation.

● Prior auditing and/or SME experience with proven error-analysis and feedback skills.

● Strong analytical, documentation and communication abilities.

● Comfortable working with AI / technology-driven coding workflows and collaborating with data science teams

Experience auditing AI-generated or automated surgical coding outputs.

● Exposure to surgical sub-specialties (e.g., orthopedics, ENT, cardiothoracic, neurosurgery).

● Experience contributing to SOPs, quality frameworks or coder training programs. .

Benefits:

- Provident Fund

Work Location: In person

📌 Quality Control Analyst -SME– Surgery Coding (India)
🏢 Rapid Claims
📍 India