Job Summary:

We are seeking a Quality Medical Coders Analyst to ensure accuracy, compliance, and efficiency in medical coding across multiple specialties, including surgery and other complex procedures. The ideal candidate will review, analyze, and validate medical coding, ensuring adherence to industry regulations, payer guidelines, and clinical documentation standards. Additionally, the role involves research and development to determine the appropriate CPT, ICD-10, and HCPCS codes for various specialties and providers.

Key Responsibilities:1. Quality Assurance & Compliance

- Scrub and validate medical codes for accuracy, completeness, and compliance with CPT, ICD-10, HCPCS, and payer guidelines.
- Ensure coding meets regulatory standards, NCCI edits, and medical necessity guidelines.
- Identify and correct coding errors, ensuring optimal reimbursement and reduced denials.
- Perform root cause analysis on denials and recommend corrective actions.

2. Research & Development

- Stay updated on changes in medical coding regulations, CMS guidelines, and specialty-specific coding updates.
- Research and assign the correct codes based on provider specialization and procedures performed.
- Collaborate with physicians, billing teams, and auditors to improve documentation and coding accuracy.

3. Provider & Specialization Coding Support

- Determine which codes align with each provider’s specialty and services.
- Provide guidance on best coding practices for different medical specialties, including surgical coding.
- Develop coding reference materials and training resources for providers and coders.

4.



Auditing & Reporting

- Conduct internal coding audits to ensure compliance with payer policies.
- Document and report findings, trends, and areas of improvement to coding leadership and compliance teams.
- Track and analyze coding performance metrics, such as denial rates, error trends, and coder accuracy.

Qualifications & Skills:

- Certification: CPC, CCS, or equivalent (Required).
- Experience: Minimum 3-5 years in medical coding with expertise in surgical coding and multi-specialty coding.
- Technical Proficiency: Strong knowledge of EHR/EMR systems, coding software, and payer guidelines.
- Analytical Skills: Ability to analyze and interpret medical records, coding patterns, and compliance risks.
- Research Abilities: Strong knowledge of medical terminology and the ability to develop procedural coding guidelines per specialty.
- Attention to Detail: Ability to spot inconsistencies and ensure accurate code assignment.
- Communication Skills: Ability to collaborate with physicians, billing staff, and compliance teams effectively.

Preferred Qualifications:

- Experience with risk adjustment coding (HCC), DRG validation, or payer audits.
- Knowledge of Medicare, Medicaid, and private payer guidelines.
- Prior experience in training coders or conducting provider education.

Work Environment:

- Remote / Hybrid / On-site (as per company policy)
- Versatile schedule, depending on audit and compliance needs

Job Type: Full-time

Pay: ₹30,000.00 - ₹70,000.00 per month

Benefits:

- Flexible schedule

Work Location: In person

📌 Medical coding quality analyst (Hyderabad)
🏢 Healthy Horizons Clinic
📍 Hyderabad