Quality Analyst – HCC / E&M (CRC Certified) Profee Coding
Location: Chennai, India
Company: Guidehouse
Department: Coding Quality Operations (India)
Employment Type: Full-Time
Role Summary
The Quality Analyst – HCC / E&M (CRC Certified) Profee Coding is responsible for conducting coding quality reviews, ensuring coding accuracy, maintaining compliance with coding guidelines, and supporting continuous improvement initiatives within professional fee (Profee) coding operations. The role focuses on auditing coded medical records, identifying coding risks, mentoring coders, and supporting quality governance programs.
This position requires expertise in HCC coding, Evaluation & Management (E&M) coding, ICD, CPT, reimbursement methodologies, coding audits, and healthcare compliance standards while serving as a key contributor to coding quality and operational excellence.
Key Responsibilities
Coding Quality Audits & Review
Review medical records to validate coding accuracy and compliance.
Audit:
Primary Diagnoses
Secondary Diagnoses
Procedure Codes
Evaluation & Management (E&M) Services
HCC Risk Adjustment Coding
Verify correct assignment of:
ICD Codes
CPT Codes
Modifiers
Risk Adjustment Codes
Ensure coding follows official coding guidelines and payer requirements.
Clinical Documentation & Coding Validation
Analyze medical documentation for completeness, accuracy, and coding appropriateness.
Review records involving:
Ambiguous Documentation
Incomplete Records
Complex Coding Scenarios
Identify documentation gaps impacting reimbursement and coding accuracy.
Recommend coding corrections and documentation improvements.
Reimbursement & Compliance Review
Ensure coding supports compliant reimbursement.
Validate:
MS-DRG Assignments
APC Assignments
Professional Fee Coding
HCC Capture Opportunities
Review coding against:
Official Coding Guidelines
Regulatory Requirements
Client-Specific Standards
Identify compliance risks and recommend corrective actions.
Quality Monitoring & Reporting
Monitor daily quality production and audit schedules.
Ensure agreed sampling targets and quality benchmarks are achieved.
Document audit findings within Guide Audit and other quality systems.
Generate reports highlighting:
Coding Accuracy Trends
Risk Areas
Quality Gaps
Educational Opportunities
Provide data-driven recommendations to improve coding performance.
Coder Mentoring & Knowledge Support
Serve as a coding quality resource for coding teams.
Respond to coding queries and provide technical guidance.
Escalate complex coding issues to leadership when required.
Mentor coders and support development of coding competencies.
Promote coding standardization and best practices across teams.
Training & Education Support
Identify recurring coding errors and training needs.
Support development and delivery of:
Coding Education Programs
Refresher Sessions
Continuing Education Initiatives
Assist with creation of quality improvement plans.
Collaborate with US quality teams and operational stakeholders on training strategies.
Quality Governance & Meetings
Coordinate and participate in:
Quality Review Meetings
Coding Governance Discussions
Operational Quality Reviews
Present audit findings and improvement recommendations.
Track closure of quality-related action items.
Support organizational quality objectives.
Project Launch & Operational Support
Participate in project launch activities.
Understand client-specific coding requirements and workflows.
Provide quality oversight during:
New Client Implementations
Process Transitions
Special Projects
Support focused audits and coding quality initiatives.
Research & Special Projects
Assist in:
Coding Research Activities
Quality Improvement Projects
Client-Specific Audit Programs
Continuing Education Development
Support presentation and dissemination of coding knowledge across teams.
Information Security & Compliance
Protect confidentiality, integrity, and availability of information assets.
Comply with:
Information Security Policies
Healthcare Compliance Standards
Data Privacy Requirements
Report information security incidents through established channels.
Adhere to ethical coding standards established by AHIMA and industry regulatory bodies.
Required Qualifications
Education
One of the following qualifications:
Bachelor's Degree in:
Life Sciences
Allied Health Sciences
Pharmacy
Nursing
Healthcare Administration
Related Healthcare Discipline
Certification (Mandatory)
One or more of the following:
CRC (Certified Risk Adjustment Coder)
CCA (Certified Coding Associate)
CCS (Certified Coding Specialist)
CPC (Certified Professional Coder)
CPC-H
Other AHIMA / AAPC Certifications
Experience
Minimum 5+ years of medical coding experience.
Minimum 3+ years of coding quality audit or quality review experience.
Experience in:
HCC Coding
Risk Adjustment Coding
E&M Coding
Professional Fee Coding (Profee)
Coding Audits
Coding Quality Programs
Experience reviewing complex clinical documentation and coding scenarios.
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