质量分析师 - 门诊医疗编码 (IVR/SDS) - 远程办公
Quality Analyst - Outpatient Medical Coding (IVR/SDS) - WFH
加入我们充满活力的团队，在医疗保健行业产生有意义的影响。你将在确保准确理赔处理的同时，在一个支持性强、创新的环境中提升自己的职业生涯。入职即可享受具有竞争力的福利，持续的职业发展机会，以及每天帮助他人的满足感。在 Med-Metrix 开启职业生涯的新篇章！
加入 Med-Metrix，体验这些卓越的福利！
- 全职远程办公
- 固定周末休息
- 雇佣当天提供 HMO 医疗保险，包含两名家属免费覆盖
- 团体人寿保险
- 医疗现金津贴
- 大米津贴
- 服装津贴
- 节日礼物
- 哀悼援助
- 带薪休假
- 培训与员工发展
- 员工参与活动
- 内部晋升机会
职位描述：
质量分析师（SDS/IVR）负责确保同日手术（SDS）和介入放射学（IR）服务中准确、合规且一致的编码。该职位负责执行审计、纠正措施、编码员指导以及合作伙伴沟通，以推动质量成果，减少拒付，并提高文档与付款人和监管要求的一致性。
职责：
1. 审计与质量控制：
- 对 SDS 和 IR 接诊进行审计（随机、定向、基于 RCA/CAPA 的审计）。
- 验证 CPT/HCPCS 和 ICD-10-CM 编码、修饰符、单位和费用捕获的一致性。
- 根据 NCCI 编辑、MUE、LCD/NCD 指导、付款人政策和设施特定规则进行合规性验证。
- 评估文档充分性（手术记录、影像报告、荧光透视时间、镇静、设备详情、导管位置/方法、血管区域）。
- 介入放射学重点
- 审查血管和非血管 IR 程序的编码选择（例如，栓塞、溶栓、球囊扩张/支架植入、TIPS、透析干预、胆道/泌尿引流、活检）。
- 验证选择性与非选择性导管插入家族、影像监督与解释（S&I）编码、引导模式和捆绑规则。
- 确保附加编码、分期/相关程序和侧别的正确应用。
3. SDS 重点
- 审计门诊手术病例（例如，内窥镜检查、骨科内窥镜手术、小手术、疼痛管理）的 CPT/HCPCS/ICD-10-CM 编码和修饰符使用是否正确。
- 确认诊断与程序的正确关联，以及符合设施计费规则和门诊状态标准。
查看英文原文
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