Medical Coding - QCA - Associate

Location: Chennai  •  Level: Mid Level  •  Openings: 1  •  Type: Full-time
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Job description

Job Title: QCA – Denials / EM / Surgery
Job Location: Chennai
Work Model: Work from office
Candidate Expectations
Total and Relevant Experience – 3 Years to 6 Years
Candidate Location - Anywhere
Skills – QCA, Denials, E&M, or Surgery coding
Candidate Industry (Life science)
Diversity – No
Education and Certification
Qualification: Any Life Science Graduate
Specific Remarks: Distance education not accepted.
Certification:  
·                                 CPC – Certified Professional Coder
  • CCS – Certified Coding Specialist
  • CIC – Certified Inpatient Coder
  • Relevant medical coding certifications.
Detailed Job Description
QCA – Quality Coding Audit
·        Perform quality audits of medical coding records to ensure coding accuracy.
·        Review ICD-10-CM, CPT, and HCPCS codes for compliance.
·        Identify coding errors, provide feedback, and recommend corrective actions.
·        Monitor coding accuracy, productivity, and quality metrics.
·        Conduct root cause analysis and support coder training.
Denials Management
  • Review medical coding-related claim denials and identify root causes.
  • Analyze denials related to incorrect coding, modifiers, medical necessity, and documentation.
  • Review EOBs, payer guidelines, and denial reason codes.
  • Support claim corrections, appeals, and resubmissions.
  • Work on denial prevention and improvement initiatives.
E&M – Evaluation & Management
  • Review and assign appropriate E&M codes based on provider documentation.
  • Understand office visits, hospital visits, consultations, and emergency department coding.
  • Apply appropriate medical decision-making (MDM) and time-based coding guidelines.
  • Ensure accurate code selection as per current CPT guidelines.
Surgery Coding
  • Review operative reports and assign appropriate CPT codes.
  • Apply knowledge of surgical procedures, anatomy, and medical terminology.
  • Ensure correct usage of modifiers and bundling/unbundling guidelines.
  • Understand NCCI edits and global surgical package rules.
  • Ensure coding compliance with payer and regulatory guidelines.
Key Skills
  • Strong knowledge of ICD-10-CM, CPT, and HCPCS.
  • Good understanding of medical terminology and anatomy.
  • Knowledge of coding compliance and payer guidelines.
  • Experience in QCA, Denials, E&M, or Surgery coding.
  • Strong analytical and communication skills.
  • Ability to meet quality and productivity targets.
Other Specific Remarks
Additional Requirements: Proper documents for entire career and PF Form 16 Mandatory

Job ID: 2047