Job Title

Quality Control Analyst (QCA) – Medical Coding

Experience

4–5 years in Medical Coding (with auditing/QC exposure preferred)

Job Summary

The Quality Control Analyst (QCA) is responsible for auditing and ensuring the accuracy and compliance of medical coding across Evaluation & Management (E&M), Outpatient (OP), Inpatient (IP), and Surgery coding. The role involves reviewing coded charts, identifying errors, providing feedback, and driving quality improvements in alignment with coding standards and client requirements.

Key Responsibilities

Perform quality audits on coding for E&M, OP, IP, and Surgical cases
Validate accurate assignment of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes
Ensure compliance with AAPC/AHIMA guidelines, payer policies, and client SOPs
Identify coding errors, gaps, and documentation deficiencies
Provide detailed feedback and coaching to coders to improve quality
Track and report quality metrics, error trends, and audit findings
Conduct calibration calls with internal teams and refresher sessions for existing coder
Support denial analysis and prevention strategies
Ensure adherence to TAT, productivity, and accuracy benchmarks

Required Skills & Competencies

Strong expertise in E&M coding
Outpatient and Inpatient coding
Surgical coding (CPT & ICD-10-PCS)
In-depth knowledge of ICD-10-CM, CPT, HCPCS
Knowledge of NCCI edits and modifier usage
Excellent auditing and analytical skills
Strong communication and feedback delivery skills
Proficiency in Excel and reporting tools

Qualifications

Graduate in Life Sciences / Medical / Paramedical field
Certifications such as CPC / CCS / CIC preferred

Key Performance Indicators (KPIs)

Audit accuracy (%)
Error detection rate
Reduction in repeat errors
Adherence to SLA/TAT
Team quality improvement metrics