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Quality Analyst – Hcc/E&M (Crc Certified) Professional Medical Coding

Guidehouse
Guidehouse
5+ years
preferred by company
PAN-India, India
1 May 12, 2026
Job Description
Job Type: Full Time Education: M.Pharm/B.Pharm or M.Sc. Skills: Environment, Experiments Design, Health And Safety (Ehs), Laboratory Equipment, Manufacturing Process, Materials Science, Process Simulation, Sop (Standard Operating Procedure), Technical Writing, Wat, GCP guidelines, gmp knowledge, HSE Knowledge , Logistics and Transportation Management, Master Data, Operational Excellence, Sap Erp, supply chain management, Supply Planning, Warehouse Management, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines

Quality Analyst – HCC/E&M (CRC Certified) Professional Medical Coding

Job Type: Full-Time
Job Category: Medical Coding / Healthcare Quality Assurance / Revenue Cycle Management
Experience Required: 5+ Years
Freshers Eligible: No
Travel Requirement: None
Industry: Healthcare / Medical Coding / Healthcare BPO / Revenue Cycle Management

Job Overview

We are hiring an experienced Quality Analyst – HCC/E&M Professional Medical Coding for a healthcare coding quality assurance role. This opportunity is ideal for certified medical coding professionals with strong expertise in HCC coding, E&M coding, professional fee coding (Profee), coding audits, compliance review, and healthcare reimbursement quality assurance.

The selected candidate will play a critical role in monitoring coding quality, reviewing medical documentation accuracy, ensuring compliance with coding guidelines, mentoring coding teams, and supporting healthcare revenue cycle performance through high-quality coding audit processes.

This position is best suited for experienced healthcare coding professionals with leadership exposure in quality assurance, audit operations, and medical coding compliance.

Key Responsibilities

  • Plan, monitor, and manage daily quality assurance production to ensure delivery timelines are consistently met.
  • Coordinate with coding operations leadership to address workflow disruptions, system issues, or operational delays.
  • Create and maintain practical weekly quality review schedules aligned with client expectations.
  • Review medical records for accurate assignment of primary and secondary diagnoses, CPT codes, ICD coding, and procedure documentation.
  • Audit coding quality to ensure compliance with medical coding standards, reimbursement guidelines, and documentation accuracy.
  • Validate sequencing of diagnoses and procedures based on official coding regulations and payer requirements.
  • Review complex cases where documentation is ambiguous, incomplete, or requires advanced coding judgment.
  • Ensure accurate reimbursement optimization for hospital and professional healthcare billing services.
  • Respond to daily quality-related coding queries and escalate critical concerns to coding leadership when necessary.
  • Meet established sampling accuracy benchmarks and QA performance metrics.
  • Record audit findings in QA management systems for reporting, training analysis, and risk identification.
  • Support development of training programs, coding standardization initiatives, and continuous quality improvement processes.
  • Mentor coding professionals and provide quality-based performance feedback.
  • Coordinate scheduled QA meetings with coding and production teams.
  • Participate actively in client onboarding, project launches, focused audits, and operational quality initiatives.
  • Maintain compliance with healthcare information security policies and confidentiality requirements.
  • Report information security concerns or compliance incidents through proper internal channels.

Required Qualifications

  • Accredited medical coding certification such as:
    • CRC (Certified Risk Adjustment Coder)
    • CCA (Certified Coding Associate)
    • CCS (Certified Coding Specialist)
    • CPC (Certified Professional Coder)
    • CPC-H or equivalent certification
  • Strong professional experience in healthcare coding quality assurance or medical coding audit roles.
  • Deep understanding of healthcare reimbursement methodologies and coding compliance.

Experience Requirements

  • Minimum 5+ years of total experience in medical coding
  • At least 3+ years of relevant experience in coding quality assurance, audit, or advanced coding review
  • Freshers are not eligible

Required Technical Skills

  • HCC Coding
  • E&M Coding
  • Professional Fee Coding (Profee)
  • Medical Coding Quality Assurance
  • Coding Audits
  • ICD Coding
  • CPT Coding
  • Healthcare Documentation Review
  • Coding Compliance Management
  • Revenue Cycle Management
  • Risk Adjustment Coding
  • Quality Reporting
  • Clinical Documentation Analysis

Preferred Skills

  • Microsoft Excel
  • Microsoft Word
  • Microsoft PowerPoint
  • Team Mentorship
  • Process Improvement
  • Quality Reporting & Analytics
  • Cross-functional Communication
  • Problem Solving
  • Project Coordination