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Medical EM OP QA / QC

Medical EM OP QA / QC

ConfidentialChennai
9 days ago
Job description

We are seeking a highly detail-oriented Medical EM (Evaluation and Management) OP (Outpatient) Quality Assurance (QA) / Quality Control (QC) specialist. The ideal candidate will have expert knowledge of EM and Outpatient coding guidelines , ensuring the highest standards of coding accuracy , compliance , and documentation integrity for outpatient encounters. This role is crucial for accurate billing and efficient revenue cycle management.

Key Responsibilities

  • Conduct rigorous QA / QC reviews of Evaluation and Management (E&M) and Outpatient (OP) medical coding.
  • Identify and analyze coding discrepancies, documentation deficiencies, and compliance risks specific to E&M and Outpatient services.
  • Provide precise and constructive feedback to coders to improve their accuracy and understanding of complex E&M rules.
  • Ensure all coding practices comply with official coding guidelines (e.g., CPT, ICD-10-CM), payer requirements, and industry standards.
  • Collaborate with coding teams and clinical documentation specialists to enhance documentation quality .
  • Participate in the development and implementation of quality improvement programs and training materials.
  • Track and report on coding accuracy rates and identified error trends.

Qualifications

  • Certification : Must be a certified professional coder with expertise in EM and Outpatient coding .
  • Experience : Proven experience in EM / Outpatient medical coding and / or auditing .
  • Skills

  • Exceptional attention to detail and strong analytical skills.
  • In-depth knowledge of E&M guidelines , CPT, and ICD-10-CM coding for outpatient services.
  • Ability to effectively interpret complex clinical documentation for accurate code assignment.
  • Excellent communication and interpersonal skills for providing feedback and collaborating across teams.
  • Proficiency in medical coding software and electronic health record (EHR) systems.
  • Skills Required

    Quality Control, Documentation, coding practices

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