E/M Quality Analysis

Role & responsibilities

• Conduct retrospective and prospective audits of coded records to evaluate accuracy, consistency, and compliance with applicable coding guidelines (e.g., ICD-10-CM, CPT, E/M guidelines, and payer-specific requirements)
• Identify documentation and coding gaps, trends, and opportunities for improvement across service lines, with a focus on high-risk areas such as E/M, ED, and specialty coding
• Provide clear, actionable feedback to coders and providers, including detailed audit results and education on best practices
• Develop and deliver coding and documentation education based on audit findings, regulatory updates, and organizational priorities
• Collaborate with CDI, revenue cycle, compliance, and clinical leadership to ensure accurate capture of clinical complexity and appropriate reimbursement
• Support internal and external audit activities, including payer audits, regulatory reviews, and compliance initiatives
• Track and report key performance metrics, including coding accuracy rates, error trends, and audit outcomes
• Assist in the development and maintenance of coding policies, procedures, and training materials
• Serve as a subject matter expert for coding-related inquiries, providing guidance on complex cases and documentation scenarios
• Stay current on regulatory changes, coding updates, and industry best practices, and ensure timely dissemination of relevant information.

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Thanks & Regards,

Navya Miryalkar

Advantum Health