Same Day Surgery QA

Role & responsibilities

• Review and analyze medical records, operative notes, and physician documentation for Same Day Surgery cases.
• Assign accurate ICD-10-CM, CPT, and HCPCS codes based on clinical documentation.
• Code outpatient surgical procedures, diagnoses, complications, and comorbidities as applicable.
• Ensure accurate CPT coding, modifiers, bundling, and NCCI edits as per coding guidelines.
• Validate medical necessity and ensure diagnosis-to-procedure coding accuracy.
• Identify documentation gaps and raise physician queries when required.
• Follow AMA CPT, ICD-10-CM, CMS, and payer-specific coding guidelines.
• Perform quality checks to maintain coding accuracy and compliance.
• Meet defined productivity, quality, and turnaround-time (TAT) targets.
• Review and resolve coding-related errors, denials, and client queries.
• Stay updated with annual changes in ICD-10-CM, CPT, HCPCS, and payer guidelines.
• Maintain patient confidentiality and comply with HIPAA and organizational policies.

Preferred candidate profile

• Graduate in Life Sciences, Nursing, Pharmacy, Allied Health Sciences, or Medical-related fields.
• 13 years of experience in medical coding, preferably in Same Day Surgery / Outpatient / Ambulatory Surgery coding.
• Strong knowledge of ICD-10-CM, CPT, HCPCS, and modifiers.
• Good understanding of surgical procedures, anatomy, and medical terminology.
• Experience with Surgery/Outpatient coding and knowledge of NCCI edits and bundling guidelines.
• CPC, CCS, CCA, or equivalent medical coding certification is preferred.
• Good analytical and documentation-review skills.
• Ability to meet quality, productivity, and TAT targets.
• Good written and verbal communication skills.
• Willingness to work in US healthcare / night shifts if required.
• Candidates with experience in US healthcare RCM and medical coding will be preferred.

Contact : Tharshini HR - [phone removed]