Medical Coding Quality Assurance (QA) Specialist

Full-time Management & Operations

Pay: ₱40,000.00 - ₱50,000.00 per month

Job Summary

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

Key Responsibilities

• 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 according to AHA Coding Clinic and CMS regulations.
• Ensure adherence to hospital policies, payer requirements, and regulatory standards. Maintain audit logs, scorecards, and reports.
• Provide detailed feedback to coders based on audit findings. Recommend educational topics and assist in coder training programs....