Join our dynamic team and make a meaningful impact in the healthcare industry. You'll play a pivotal role in ensuring accurate claims processing while advancing your career in a supportive and innovative environment. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of helping others every day. Take the next step in your career with Med-Metrix!
Experience these exceptional benefits when you join Med-Metrix!
- Fulltime Permanent Remote
- Fixed Weekends Off
- Day 1 HMO with 2 of your dependents covered for FREE
- Group Life Insurance
- Medical Cash Allowance
- Rice Allowance
- Clothing Allowance
- Holiday Gift
- Bereavement Assistance
- Paid Time Off
- Training and Staff Development
- Employee Engagement Activities
- Opportunities for Internal Mobility
Job Description:
The Quality Analyst (SDS/IVR) ensures accurate, compliant, and consistent coding across Same Day Surgery (SDS) and Interventional Radiology (IR) services. This role leads audit execution, corrective actions, coder coaching, and partner communication to drive quality outcomes, reduce denials, and improve documentation alignment with payer and regulatory requirements.
Responsibilities:
1. Audit & Quality Control:
- Perform audits for SDS and IR encounters (random, targeted, RCA/CAPA-driven).
- Validate CPT/HCPCS and ICD-10-CM assignment, modifiers, units, and charge capture alignment.
- Verify compliance against NCCI edits, MUEs, LCD/NCD guidance, payer policies, and facility-specific rules.
- Assess documentation sufficiency (operative notes, imaging reports, fluoroscopy time, sedation, device details, catheter positions/approaches, vascular territories).
- Interventional Radiology Focus
- Review code selection for vascular and non-vascular IR procedures (e.g., embolization, thrombolysis, angioplasty/stenting, TIPS, dialysis interventions, biliary/urinary drainage, biopsies).
- Validate selective vs. non-selective catheterization families, imaging supervision & interpretation (S&I) codes, guidance modalities and bundling rules.
- Ensure correct application of add-on codes, staged/related procedures, and laterality.
3. SDS Focus:
- Audit outpatient surgical cases (e.g., endoscopy, orthopedic scope procedures, minor surgeries, pain management) for correct CPT/HCPCS/ICD-10-CM assignment and modifier use.
- Confirm correct linkage of diagnosis to procedures and adherence to facility billing rules and outpatient status criteria.
4. Performance Improvement and Training:
- Produce clear audit findings, trend analyses, and actionable recommendations.
- Conduct coder feedback sessions, 1:1 coaching, and targeted refreshers (playbook alignment), as needed.
- Partner with Training/Ops for ramp-ups, glide paths, and competency validations.
5. Operations & Governance:
- Maintain audit schedules, sampling plans, and documentation in QA trackers.
- Collaborate with leadership on denials prevention and compliance escalations.
6. Utilize Coding Software:
- Utilize coding software systems and tools effectively to assign accurate procedure and diagnosis codes, abstract medical records, and generate coded data for billing and reporting purposes.
Required Qualifications
- Education: Bachelor’s degree in a health-related field (e.g., Nursing, Allied Health, HIM) or equivalent experience.
- Certifications: Must have CPC certification. CIRCC (strongly preferred for IVR)
• Experience:
- Solid 2 years of SDS/IR QA experience.
- Background in Outpatient (SDS, IVR/CARDIO, OBS, ED, ANCI, & RADIOLOGY)
Skills & Competencies
- Advanced IR coding proficiency (catheterization hierarchies, S&I, bundling).
- SDS coding expertise (minor/complex outpatient procedures, correct modifiers).
- Exceptional written/verbal communication and coaching skills.
- High attention to detail; ability to work independently and with cross-functional teams.
- Proficiency with encoder tools, EMR/EHRs, and audit platforms.
Working Conditions
- Schedule: Standard business hours with flexibility for cross-geo collaboration.
- Work Mode: Remote
- Data Security: Strict adherence to HIPAA-equivalent privacy and organizational confidentiality policies.
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.
Originally posted on Himalayas