Job Description: Pathology Medical Coding QA Specialist
Job Summary:
The Pathology Medical Coding QA Specialist is responsible for reviewing, auditing, and validating coding accuracy for pathology reports and laboratory results. This position ensures compliance with national coding guidelines, payer policies, and HIPAA regulations. The QA specialist identifies, reports, and corrects coding errors, provides feedback to coding staff, and assists in reducing denial rates.
Key Responsibilities:
- Audit & Review: Perform audits on Pathology and Laboratory reports (surgical pathology, molecular, cytology, and, if applicable, related skilled billing).
- Accuracy Validation: Verify correct diagnosis (ICD -10 -CM) and procedure (CPT/HCPCS) code selection based on provider documentation.
- Quality Reporting: Document audit findings and, for quality improvement, provide detailed, actionable feedback to coding staff to correct errors.
- Compliance: Ensure all codes adhere to AMA, CMS, and payer -specific guidelines.
- Denial Management: Review and analyze claim denials for coding inaccuracies and assist in the appeals process.
- Education: Keep up -to -date on changes in pathology coding, including CPT updates for laboratory tests.
Required Skills & Qualifications:
- Experience: 3–5 years of specialized medical coding experience, with at least 1–2 years in a dedicated pathology/laboratory coding or auditing role.
- Certifications: Must hold a current certification from AAPC or AHIMA (e.g., CPC, CCS, or specialized CPC -P).
- Technical Knowledge: Deep understanding of anatomy, physiology, and pathology procedures.
- Software Proficiency: Experience with electronic health records (EHR) and coding software.
- Communication: Ability to interact effectively with pathologists and billing teams.
Preferred Qualifications:
- Previous experience in quality auditing (QA) or coding education.
- Associate or Bachelor’s degree in Health Information Management.
📌 Pathology QA (Hyderabad)
🏢 Nameless
📍 Hyderabad
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