Quality Analyst – IP DRG Coding
Job ID: 35906
Job Family: Coding Quality IP (India)
Job Type: Full-Time
Location: India
Company: Guidehouse
Travel Requirement: None
Experience Required
Minimum 3+ years of experience in Inpatient (IP) DRG coding.
Minimum 1 year of experience in IP coding audit or quality assurance activities.
Educational Qualification and Certification
Graduate in any discipline (healthcare or life sciences preferred).
Mandatory certification: CIC (Certified Inpatient Coder), CCS (Certified Coding Specialist), or CPC (Certified Professional Coder).
Role Overview
Guidehouse is seeking a Quality Analyst – IP DRG Coding responsible for monitoring coding quality, auditing inpatient records, and ensuring compliance with coding standards and regulatory requirements. The role focuses on reviewing medical documentation, validating diagnosis and procedure coding, ensuring accurate DRG assignment, and supporting quality assurance initiatives in healthcare revenue cycle operations.
The position requires expertise in inpatient coding, audit processes, reimbursement systems, and regulatory compliance. This role also involves mentoring coding teams, managing quality schedules, and supporting continuous improvement initiatives.
Key Responsibilities
Plan, monitor, and evaluate quality assurance production activities to ensure operational targets and deadlines are achieved.
Develop and maintain quality schedules in coordination with coding operations teams and management.
Review medical records to validate accurate code assignment for primary and secondary diagnoses and procedures.
Ensure correct sequencing of diagnoses and procedures according to coding guidelines.
Validate MS-DRG and APC assignments to support accurate reimbursement.
Abstract and compile clinical data from medical records to support compliant hospital and professional billing.
Review complex coding scenarios where documentation is incomplete, ambiguous, or unclear.
Respond to queries from quality staff and escalate issues to leadership when necessary.
Maintain agreed sampling targets and coding accuracy standards.
Document audit findings in quality systems to identify risk areas and support training initiatives.
Provide mentorship, guidance, and feedback to coding teams to improve coding quality and consistency.
Support project launches and coding process implementation activities.
Coordinate quality meetings with production and quality teams.
Ensure adherence to ethical coding standards and regulatory guidelines, including AHIMA standards.
Maintain updated knowledge of coding guidelines, reimbursement policies, and reporting requirements.
Support continuing education initiatives, focused audits, and special projects as required.
Demonstrate flexibility to work with different teams in a rotational environment.
Required Skills and Competencies
Strong expertise in ICD-10-PCS coding systems and inpatient coding standards.
Knowledge of ICD coding conventions, CPT-4 coding guidelines, and DRG assignment processes.
Understanding of healthcare reimbursement methodologies and regulatory compliance requirements.
In-depth knowledge of anatomy, physiology, disease processes, and surgical procedures.
Strong analytical and problem-solving capabilities.
Excellent communication and stakeholder management skills.
Attention to detail and ability to interpret complex clinical documentation.
Ability to collaborate effectively in a fast-paced healthcare environment.
Preferred Qualifications
Proficiency in Microsoft Excel, Word, and PowerPoint.
Experience in coding audit tools or quality reporting systems.
Work Environment and Benefits
Guidehouse offers a competitive compensation package, performance-based rewards, and comprehensive benefits designed to support employee growth, diversity, and workplace well-being. The organization promotes a collaborative environment focused on innovation, compliance, and continuous improvement.
About Guidehouse
Guidehouse is a global professional services firm providing consulting, technology, and managed services to public sector and commercial clients. The organization delivers innovative healthcare and financial solutions while maintaining high standards of integrity and operational excellence.
Equal Employment Opportunity
Guidehouse is an equal opportunity employer committed to providing a diverse and inclusive work environment and considers all qualified applicants in accordance with applicable laws.
Recruitment and Fraud Prevention Notice
Guidehouse does not request payment or financial information during the recruitment process. All official communications are sent through authorized company channels. Candidates should verify recruitment communications and report suspicious activity through official company contact points.
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