Professional, Quality Analysis

Job Summary

Medical Coding Professional with 6+ years of overall experience, including 2-3 years of Quality Analysis (QA) experience in physician and outpatient coding.

Expertise in Professional Fee (ProFee) Evaluation Management (E/M) coding with thorough knowledge of CMS, CPT, ICD-10-CM, and HCPCS guidelines.

Experienced in auditing and reviewing Pain Management procedures for coding accuracy, compliance, and documentation integrity.

Specialized in coding and QA for Joint Injections, Nerve Blocks, Facet Joint Injections, Trigger Point Injections, Radiofrequency Ablation (RFA), and Spinal Cord Stimulator Implant procedures.

Conduct detailed coding audits, error trend analysis, and root cause identification to improve coding quality and accuracy.

Provide coder feedback, education, and mentoring to ensure adherence to client-specific and regulatory coding standards.

Analyze provider documentation to validate code selection, modifier usage, and medical necessity requirements.

Monitor quality metrics, prepare audit reports, and recommend process improvements to enhance operational efficiency.

Strong understanding of compliance requirements, payer policies, and risk adjustment implications in ProFee coding.

Proven ability to maintain high coding accuracy, support continuous quality improvement initiatives, and meet organizational performance goals.

Required Skills

• Productivity
• Quality
• Job Knowledge

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