Quality Analyst

Infinx · India

Immediate hiring for Quality Analysts role in Medical Coding department.

Medical Coding Quality Analysts

• Anesthesia
• Radiology
• Pathology

Job Summary

The Medical Coding Quality Analyst is responsible for auditing and reviewing medical coding activities related to Anaesthesia, Radiology, and Pathology services to ensure coding accuracy, compliance, and adherence to ICD-10-CM, CPT, HCPCS, payer-specific guidelines, and regulatory requirements. The role involves conducting quality audits, providing coder feedback, analyzing trends, and driving continuous quality improvement initiatives.

Key Responsibilities

Quality Audits & Coding Reviews

• Perform retrospective and concurrent audits of Anaesthesia, Radiology, and Pathology coding.
• Review coded charts for accuracy, completeness, and compliance.
• Validate assignment of ICD-10-CM, CPT, HCPCS, and modifier usage.
• Ensure proper documentation supports coded services.
• Identify coding errors and determine root causes.

Specialty-Specific Auditing

Anaesthesia

• Audit anesthesia time units, base units, and physical status modifiers.
• Review anesthesia modifiers (AA, QK, QX, QY, QS, etc.).
• Verify medical direction and supervision requirements.
• Ensure compliance with payer-specific anesthesia billing guidelines.

Radiology

• Review diagnostic and interventional radiology coding.
• Validate professional and technical component modifiers (26, TC).
• Audit radiology reports for documentation adequacy.
• Ensure proper coding of imaging procedures and contrast administration.

Pathology

• Audit pathology and laboratory CPT coding.
• Review specimen handling, pathology interpretation, and laboratory testing codes.
• Validate medical necessity and supporting documentation.
• Ensure correct use of pathology panels and molecular diagnostic codes.

Quality & Compliance Management

• Monitor adherence to AAPC, AHIMA, CMS, NCCI, and payer guidelines.
• Identify compliance risks and recommend corrective actions.
• Support internal and external audits.
• Maintain audit documentation and quality records.