Quality Auditing Analyst, Manila

Job Title: Hospital Medical Coding Quality Assurance (QA) Specialist 

Location: Manila 

Job Type: Full-time 

Experience: Minimum 35 years hospital coding experience,

             12 years in QA/auditing preferred. 

Job Summary 

The QA Specialist ensures accuracy, compliance, and integrity of hospital medical coding for inpatient and outpatient records. This role involves auditing coded encounters, validating DRG/APC assignments, and supporting coding teams through education and feedback. 

Key Responsibilities:  

Audit & Review: 

Conduct retrospective and concurrent audits of hospital-coded records (inpatient, outpatient, day surgery). 

Validate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes for accuracy and compliance with official guidelines. 

Review DRG/APC assignments and sequencing claims per AHA Coding Clinic and CMS regulations. 

Compliance & Documentation: 

Ensure adherence to hospital policies, payer requirements, and regulatory standards. 

Maintain audit logs, scorecards, and prepare reports for management. 

Education & Feedback: 

Provide detailed feedback to coders based on audit findings. 

Recommend educational topics and assist in coder training programs. 

Collaboration: 

Work with Clinical Documentation Integrity (CDI) teams to resolve mismatched DRGs and improve documentation. 

Participate in denial management and appeal processes for coding-related issues. 

Continuous Improvement: 

Identify trends, risks, and recommend process improvements. 

Stay updated on coding guidelines and reimbursement changes. 

Certifications: 

CCS, CIC, CPC, CPMA or equivalent coding certification required. 

Skills: 

Experience in hospital-based coding audits and denial management. 

Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, DRG/APC assignment. 

Familiarity with EMR systems and coding tools (e.g., 3M, Optum, Meditech). 

Excellent analytical and communication skills. 

Ability to interpret complex medical documentation and apply coding guidelines accurately.