Quality Analyst - Facility IP DRG

Job Family

Coding Quality IP (India)

None

None

• Plans, monitors, directs, and evaluates QA production on a daily basis. Ensures that daily schedules are met and communicates with Director and Coding Operations if situations occur that hinder meeting deadlines.
• Implements measures/schedules to return to established schedules at the earliest possible time when system issues or other emergencies delay QA, working closely with each quality specialist.
• Ensures the QA communicates a valid, workable schedule for his or her client each week. Accurate, sensible, and on time. If this doesn’t happen properly, it is the responsibility of the Lead QA Specialist to make it happen promptly.
• Reviews medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 coding conventions.
• Sequences the diagnosis and procedures using coding guidelines and ensures MS-DRG/APC assignment is accurate when applicable.
• Abstracts and compiles data from medical records for appropriate optimal or complaint reimbursement for hospital and/or professional charges.
• Answers queries from the quality staff on a day-to-day basis and escalates to the Director of Coding as necessary.
• Meets agreed sampling targets and accuracy.
• Keeps abreast of coding guidelines and reimbursement reporting requirements.
• Documents QA data on teams of QA/coders and records findings in the QA system (Guide Audit) for reporting to the client, identifying risk areas, developing training and education programs, and developing/implementing standardization within the organization.
• Provides guidance and mentorship of coders.
• Ensures that continuing education is planned, scheduled, and completed for all coding/QA teams through coordination of the US.
• Coordinates scheduled quality meetings with the QA and production staff.
• Brings identified concerns to Guidehouse’s coding compliance management for discussion.
• Actively participates in project launch sessions with team leaders to understand the coding process.
• Is flexible to work with any given team as assigned in a rotational arrangement.
• Abides by the Standards of Ethical Coding set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques to effectively apply ICD-9-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Assists with research and development and the presentation of continuing education programs on areas of specialization.
• Assists with special projects as required, for example: focused audits, client launches, etc.

• Minimum 3+ years of experience in IP DRG coding specialty, 1 year of experience in IP auditing.
• Mandatory certifications such as CIC, CCS, CPC.
• Must be a graduate.
• Good communication and analytical skills.
• Experience with ICD-10-PCS coding systems, ensuring accuracy and compliance with all regulatory and reimbursement requirements.
• Day‑to‑day tasks include reviewing patient records, assigning appropriate DRGs, collaborating with clinical staff to gather accurate documentation, and participating in quality improvement initiatives.

• Experience with Microsoft Excel, Word, and PowerPoint.

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact…