Quality Assurance Lead - Medical Coding ( Surgery)

Position: Quality Assurance Specialist – Coding

Location: Aurangabad ( Sambhaji Nagar), Maharashtra

Key Responsibilities

• Conduct daily coding quality assurance (QA) reviews as a member of the QA team, under the guidance of the QA Manager.
• Perform random QA audits using internal focus lists, derived from CMS, RAC-approved issues, OIG work plan topics, and historical risk areas, as directed by the QA Manager.
• Adhere to established internal and client-specific QA guidelines at all times.
• Coordinate with designated client contacts to review departmental procedures and verify compliance.
• Prepare and present weekly QA productivity and progress reports to the QA Manager.
• Maintain strict compliance with HIPAA and all applicable privacy regulations.
• Deliver review findings and provide constructive feedback to coding staff.
• Complete assigned work within prescribed deadlines.
• Apply established guidelines and regulatory requirements (ICD-10-CM Coding Guidelines, Coding Clinic advice, MCE/OCEs) during all coding and review activities.
• Develop departmental Standard Operating Procedures (SOPs) as needed; participate in data quality and improvement initiatives across local and enterprise settings.
• Calculate and report statistical QA data accurately, identifying trends and patterns effectively.
• Provide backend support as needed.
• Work with management to identify and implement improvements to operational procedures for better efficiency and quality outcomes.

Required Skills & Knowledge

• Graduate with a minimum of 5 years of experience in medical coding, specifically focused on surgery coding.
• Currently serving in a QA, Senior Coder, or equivalent capacity and eligible to step into a Team Leader role.
• Willingness and readiness to work from the office.

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