Quality Auditing Analyst

Full-time Management & Operations

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 adhere...