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Quality Assurance Specialist

5 months ago


Pune, India Artifex HR Private Limited Full time

Quality Assurance Specialist - MCC

Experience - 5 - 7 years

Regular Shift Timings / Full Time Role - Permanent

Location: Mumbai


Roles and Responsibilities:

  • Possess Knowledge on Risk adjustment models - Medicare, Commercial and Medical aid.
  • Should be well versed in coding standards and guidelines including ICD - 10 - CM guidelines, AHA coding clinic updates and client specific guideline requirements.
  • Should be able to perform QA audits for multiple projects.
  • Derive effective QA sampling and audit methodology for the projects assigned.
  • Possess analytical skills to monitor and measure the quality trend in the coding projects.
  • Perform root cause analysis, identify knowledge gaps, and conduct training to project team.
  • Review scope document and guidelines for new clients before the start of the project and own pilot project delivery to meet client SLA on quality.
  • Review and customize standard coding guidelines as needed.
  • Identity error trends on client feedback and improve client experience by continuous improvements.
  • Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors.
  • Ability to respond to the internal coding queries with proper rationale.
  • Follow external and internal compliance standards.


Required Skills:

  1. Medical coding experience minimum of 5 years is mandatory
  2. Worked at least 1 year as an SME/ QA.
  3. Experience in any coding specialty is preferred to handle the pilot projects.
  4. Risk adjustment coding experience is an added advantage.
  5. AAPC/ AHIMA Certification is mandatory
  6. Strong Knowledge in Anatomy and Physiology.