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    Quality Analyst – Hcc / E&M / Profee Medical Coding

    Guidehouse
    Guidehouse
    5+ years
    preferred by company
    PAN-India, India
    1 May 13, 2026
    Job Description
    Job Type: Full Time Education: M.Pharm/B.Pharm or M.Sc. Skills: Communication Skills, Continual Improvement Process, Master Data, Material Requirements Planning (Mrp), Materials Management, People Management, Production Planning, Supplier Relationship Management (Srm), Supply-Chain Man, CPC Certified, Data Analysis, Document Management, Life Science, Regulatory Compliance, Waterfall Model, Environment, Experiments Design, Health And Safety (Ehs), Laboratory Equipment, Manufacturing Process, Materials Science, Process Simulation, Sop (Standard Operating Procedure), Technical Writing, Wat, GCP guidelines

    Job Title: Quality Analyst – HCC / E&M / Profee Medical Coding

    Location: India
    Job Type: Full-Time
    Experience Required: 5+ Years (Freshers are not eligible)
    Industry: Healthcare / Medical Coding / Revenue Cycle Management / Healthcare BPO / Coding Compliance
    Department: Coding Quality Assurance / Medical Coding Operations / Healthcare Quality

    About the Role
    We are seeking a highly experienced Quality Analyst – HCC / E&M / Profee Medical Coding to lead coding quality assurance, audit governance, compliance monitoring, coder mentoring, and medical documentation review within a healthcare revenue cycle environment. This role is ideal for professionals with expertise in HCC coding, Evaluation & Management (E&M) coding, professional fee (Profee) coding, CPT coding, ICD coding, coding audits, and healthcare reimbursement compliance.

    The ideal candidate will drive coding accuracy, monitor QA productivity, guide coding teams, identify documentation risk areas, and ensure compliance with coding standards, client requirements, and healthcare reimbursement regulations.

    This opportunity is best suited for experienced certified medical coding professionals with strong healthcare QA leadership capabilities.

    Key Responsibilities

    Coding Quality Assurance & Audit Management

    • Lead daily medical coding quality assurance operations to ensure productivity, quality benchmarks, and delivery timelines are achieved.
    • Monitor QA production schedules and ensure coding audit workflows remain aligned with operational deadlines.
    • Identify operational bottlenecks and implement recovery measures when quality or productivity targets are impacted.

    Medical Coding Audit Review

    • Review patient medical records for coding accuracy involving:
      • Primary diagnosis coding
      • Secondary diagnosis coding
      • Procedure coding
      • Professional fee coding
      • Healthcare reimbursement compliance
    • Validate coding assignments using established coding standards and regulatory guidelines.
    • Audit complex records involving ambiguous, incomplete, or unclear documentation requiring advanced coding interpretation.

    HCC / E&M / Profee Coding Quality Review

    • Perform expert quality review in:
      • HCC (Hierarchical Condition Category) coding
      • E&M (Evaluation and Management) coding
      • Professional Fee (Profee) coding
    • Ensure coding accuracy supports optimal reimbursement, compliance, and documentation integrity.

    CPT / ICD / Reimbursement Compliance

    • Apply advanced coding standards using:
      • CPT-4 coding guidelines
      • ICD coding frameworks
      • Medical reimbursement reporting requirements
    • Where applicable, validate MS-DRG / APC assignments and reimbursement accuracy.
    • Ensure all coding activities align with payer, compliance, and documentation standards.

    Quality Metrics & Audit Reporting

    • Document QA audit findings within designated audit systems such as Guide Audit or equivalent QA platforms.
    • Track coding risk trends, accuracy metrics, quality performance, and audit outcomes.
    • Support client reporting, risk identification, and operational quality governance.

    Coder Coaching & Mentorship

    • Provide real-time guidance to coding teams and quality staff regarding coding queries, audit findings, and compliance expectations.
    • Mentor coders to improve coding accuracy, documentation interpretation, and quality performance.
    • Support development of training and education initiatives based on identified quality gaps.

    Training & Continuing Education Support

    • Assist in planning, scheduling, and supporting continuing education programs for coding and QA teams.
    • Contribute to coding education initiatives, specialization training, and quality improvement programs.
    • Support knowledge standardization across coding teams.

    Project Launch & Operational Readiness

    • Participate actively in project launch sessions and client onboarding activities to understand coding workflows, client expectations, and process requirements.
    • Support implementation readiness and operational stabilization for new healthcare coding projects.

    Quality Meetings & Stakeholder Collaboration

    • Coordinate scheduled quality meetings with QA teams, production staff, and operational leadership.
    • Escalate coding concerns, compliance issues, and operational risks to coding leadership where required.
    • Collaborate with cross-functional teams to support coding quality excellence.

    Compliance, Security & Ethical Coding

    • Adhere to:
      • Official coding guidelines
      • AHIMA ethical coding standards
      • Organizational information security policies
      • Healthcare compliance requirements
    • Protect confidentiality, integrity, and availability of healthcare information assets.
    • Report security incidents or compliance risks as required.

    Clinical Knowledge & Coding Expertise

    • Maintain strong working knowledge of:
      • Human anatomy & physiology
      • Medical terminology
      • Disease processes
      • Surgical procedures
      • Coding reimbursement methodologies
    • Apply clinical knowledge effectively in complex coding quality reviews.

    Special Projects & Quality Initiatives

    • Support focused audits, special client initiatives, project launches, research programs, and quality improvement projects.
    • Contribute to standardization and coding governance enhancements.

     

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