Quality Specialist – Medical Coding

Company Description

Digiclarity Global Solutions specializes in medical billing, coding, and revenue cycle management for physician practices across the nation. With a mission to empower providers and patients to focus on what truly matters, Digiclarity offers end-to-end management of the practice revenue cycle coupled with exceptional client care. Our solutions are designed to help private medical practices grow their business and streamline operations. We are dedicated to delivering reliable and trusted services for the healthcare industry.

Job Overview

We are seeking an experienced Medical Coding Auditor with strong expertise in Dermatology and Evaluation & Management (E/M) coding. The ideal candidate will be responsible for performing detailed coding audits, ensuring adherence to payer and compliance guidelines, and driving continuous improvement in coding accuracy and documentation quality.

This role requires advanced knowledge of ICD-10-CM, CPT, and HCPCS codes, with a focus on dermatology procedures, office visits, biopsies, excisions, and E/M documentation levels. The position is based in Chennai (Work-from-Office) and is suitable for candidates with 2 to 4 years of experience in medical coding and auditing within specialty practices.

Qualifications and Skills

• 2 - 4 years of experience in Dermatology Coding and E/M Coding Audits.
• In-depth understanding of ICD-10-CM, CPT, and HCPCS Level II coding.
• Strong grasp of dermatology procedures, diagnoses, modifier usage, and E/M levelling (2023 AMA Guidelines).
• Working knowledge of coding compliance, payer-specific rules, and CMS/AAPC/AMA standards.
• Experienced in conducting and managing Federal, Medicare, and Commercial insurance audits to ensure accurate coding practices and compliance with payer and regulatory guidelines.
• Experience in denial management and root cause analysis preferred.
• Excellent analytical and documentation review skills with a high attention to detail.
• Strong verbal and written communication abilities for coder and provider feedback.
• Experience working with EHR systems, audit tools, and quality tracking dashboards.
• Certification: CPC, CCS, or CPMA (preferred).

Roles and Responsibilities

• Conduct comprehensive coding audits for dermatology and E/M encounters to ensure coding accuracy, compliance, and documentation completeness.
• Validate assigned codes against provider documentation for specificity, medical necessity, and payer guidelines.
• Assess E/M levels for new, established, and consultation visits in line with AMA 2023 guidelines.
• Identify coding and documentation gaps, provide feedback, and recommend corrective training.
• Collaborate with coders and providers to clarify coding discrepancies and ensure guideline consistency.
• Prepare and present audit reports, accuracy metrics, and performance dashboards.
• Drive continuous improvement initiatives by tracking error trends and coder performance.
• Stay current on coding updates, payer policies, and CMS regulations affecting dermatology and E/M services.
• Participate in compliance reviews, internal QA sessions, and process improvement discussions.
• Support new coder training and onboarding, sharing insights from audit findings.

Key Attributes

• Strong analytical and problem-solving mindset.
• Proactive approach to quality, compliance, and accuracy.
• Ability to manage multiple audits and deliver within deadlines.
• Commitment to continuous learning and professional growth in coding standards.