Quality Analyst – IP DRG Coding
Location: India
Job ID: 35906
Job Family: Coding Quality – Inpatient (IP)
Employment Type: Full-Time
Experience Required: Minimum 3+ years in IP DRG coding and at least 1 year of IP auditing experience
Travel Requirement: None
Job Overview
The Quality Analyst – IP DRG Coding is responsible for overseeing inpatient coding quality assurance processes, ensuring accuracy in diagnosis and procedure coding, and maintaining compliance with regulatory and reimbursement guidelines. The role involves reviewing medical records, monitoring quality performance, guiding coding teams, and supporting operational excellence in coding quality management.
This position plays a critical role in maintaining coding accuracy, supporting reimbursement optimization, ensuring regulatory compliance, and driving continuous improvement initiatives in healthcare coding operations.
Key Responsibilities
Plan, monitor, and evaluate daily quality assurance production activities to ensure schedules and performance targets are achieved.
Coordinate with Coding Operations and leadership to address delays, system issues, or operational challenges affecting quality processes.
Review medical record documentation for accurate assignment of primary and secondary diagnoses and procedures using ICD coding conventions and CPT guidelines.
Ensure appropriate sequencing of diagnoses and procedures in accordance with established coding standards.
Validate MS-DRG and APC assignments where applicable to ensure reimbursement accuracy.
Analyze complex or unclear medical documentation and review non-routine coding assignments.
Abstract and compile data from medical records to support compliant reimbursement for hospital and professional services.
Respond to queries from quality staff and escalate critical issues to coding leadership when required.
Achieve defined sampling targets and maintain high accuracy standards.
Stay updated with current coding guidelines, reimbursement policies, and regulatory reporting requirements.
Document quality audit findings, identify risk areas, and support development of training and education programs.
Provide mentorship and guidance to coding professionals to improve performance and standardization.
Coordinate quality meetings with production and quality assurance teams.
Support continuing education initiatives for coding and QA teams.
Participate in project launches to understand coding workflows and quality expectations.
Maintain compliance with ethical coding standards established by the American Health Information Management Association (AHIMA).
Apply knowledge of anatomy, physiology, medical terminology, disease processes, and surgical procedures in coding review activities.
Assist in research, focused audits, client launches, and other special projects as required.
Education and Experience Requirements
Bachelor’s degree from a recognized institution.
Minimum 3+ years of experience in inpatient DRG coding.
Minimum 1 year of experience in inpatient coding audit or quality assurance.
Mandatory certification such as CIC, CCS, or CPC.
Strong knowledge of ICD-10-PCS coding systems and reimbursement compliance requirements.
Experience in reviewing patient records, assigning DRGs, and supporting documentation accuracy.
Strong analytical, communication, and problem-solving skills.
Preferred Skills
Proficiency in Microsoft Excel, Word, and PowerPoint.
Experience collaborating with clinical teams to improve documentation quality.
Understanding of quality improvement initiatives in healthcare coding.
Compensation and Benefits
Guidehouse offers competitive compensation along with a comprehensive benefits package designed to support employee well-being and professional growth within a diverse and inclusive workplace.
About Guidehouse
Guidehouse is a global consulting and managed services firm providing advanced solutions to clients across healthcare and other industries. The organization is committed to operational excellence, compliance, and innovation in healthcare services.
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