QA - HIM Services

Overview

Quality Auditor responsible for reviewing General Surgery medical coding for accuracy, documentation support, and compliance with coding and reimbursement guidelines.

What you'll do

• Audit surgical charts and operative reports for accurate CPT, ICD-10-CM, and HCPCS coding.
• Validate primary and additional procedure selection and surgical modifiers.
• Check medical necessity and identify unbundling or NCCI compliance issues.
• Provide feedback to coders and conduct root cause analysis for recurring errors.
• Deliver training on coding changes and payer policy updates.
• Prepare audit reports and analyze denial patterns.
• Maintain an assigned quality score of 95% or higher.

What you'll need

• 4–7 years of medical coding experience, including 1–2 years in auditing.
• Graduate or postgraduate qualification in Life Sciences or an equivalent field.
• Mandatory CPC or CCS certification.
• Strong knowledge of General Surgery coding and US healthcare reimbursement rules.
• Knowledge of anatomy, physiology, medical terminology, and pharmacology.
• Proficiency with computer tools, including MS Excel.
• Strong communication, analytical, organizational, and confidentiality skills.

Nice to have

• CPMA certification.
• CASCC certification.
• Experience with 3M Encoder, Optum, or EncoderPro.
• Familiarity with Epic, Cerner, or NextGen.

Details

• Location: Noida.
• Work involves computer-based tasks for 6–8 hours per day.
• Audits are generally expected within 24–48 hours of the coding date.