Medical Coding Quality Specialist Job Description [Updated for 2025]

In the ever-evolving world of healthcare, the role of Medical Coding Quality Specialist is increasingly crucial.

As medical practices become more complex, the demand for professionals who can accurately and efficiently manage, evaluate, and improve the quality of medical coding grows.

But let’s delve deeper: What exactly is expected from a Medical Coding Quality Specialist?

Whether you are:

• A job seeker looking to understand the core responsibilities of this role,
• A hiring manager outlining the perfect candidate,
• Or simply curious about the intricacies of medical coding quality management,

You’ve come to the right place.

Today, we introduce a customizable Medical Coding Quality Specialist job description template, crafted for seamless posting on job boards or career sites.

Let’s dive right into it.

Medical Coding Quality Specialist Duties and Responsibilities

Medical Coding Quality Specialists perform a variety of tasks to ensure that healthcare information is accurately represented in coded form.

They play an important role in medical billing and reimbursement processes and are critical in ensuring compliance with healthcare regulations.

Their duties and responsibilities include:

• Reviewing and auditing healthcare claims to ensure accuracy and completeness
• Identifying, reviewing, and rectifying coding errors
• Ensuring compliance with industry coding standards, including ICD-10, CPT, and HCPCS codes
• Providing feedback and education to coders and providers about coding quality and compliance
• Utilizing coding software and applications to assist with coding accuracy
• Keeping abreast of changes in coding guidelines and reimbursement regulations
• Assisting with the development and implementation of coding policies and procedures
• Collaborating with other healthcare professionals, such as billing specialists and health information managers, to ensure accurate and efficient billing processes

 

Medical Coding Quality Specialist Job Description Template

Job Brief

We are seeking a detail-oriented and experienced Medical Coding Quality Specialist to join our health information management team.

The ideal candidate will be responsible for reviewing, analyzing and assuring the final diagnoses and procedures as stated by the practicing providers are valid and complete.

Your responsibilities include ensuring codes assigned are in compliance with ICD and/or CPT guidelines, validating appropriate diagnosis and treatment codes, and resolving any coding related issues to maintain the accuracy and integrity of the medical coding process.

 

Responsibilities

• Perform coding quality audits and reviews to ensure compliance with coding guidelines and policies.
• Analyze and interpret patient medical records to identify and classify diagnoses and procedures for coding.
• Provide ongoing coding training and education to medical staff.
• Collaborate with medical billing department to rectify any coding-related denials or revenue cycle discrepancies.
• Prepare detailed reports on audit findings and make recommendations for improvement.
• Stay up-to-date on the latest developments in medical coding regulations and guidelines.
• Assist with special projects related to coding and documentation improvement as needed.

 

Qualifications

• Minimum of 3 years’ experience in medical coding or a related field.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification is required.
• Proficiency with ICD-10 and CPT coding.
• Knowledge of medical terminology, anatomy, and physiology.
• Proficiency in electronic health records (EHR) and coding software.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Associate’s or Bachelor’s degree in Health Information Management or a related field is preferred.

 

Benefits

• 401(k)
• Health insurance
• Dental insurance
• Retirement plan
• Paid time off
• Continuing education credits

 

Additional Information

• Job Title: Medical Coding Quality Specialist
• Work Environment: This is primarily an office-based role, with occasional remote work options. Minimal travel may be required for training purposes.
• Reporting Structure: Reports to the Health Information Management Director.
• Salary: Salary is commensurate with experience and qualifications, along with market and business considerations.
• Pay Range: $55,000 minimum to $75,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our organization. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Medical Coding Quality Specialist Do?

Medical Coding Quality Specialists play a crucial role in the healthcare sector.

They work in a range of settings including hospitals, clinics, health insurance companies, and other health-related organizations.

Their primary responsibility is to review and analyze medical billing and coding for processing.

They ensure that all codes are accurate, which involves checking diagnoses and procedures against the medical record documentation provided by healthcare professionals.

They are also responsible for ensuring the compliance of coding practices with regulatory standards and guidelines, including those related to data privacy and confidentiality.

This role requires them to conduct regular audits and provide feedback to improve the overall coding process.

Medical Coding Quality Specialists often work alongside healthcare providers, billing staff, and other professionals in the medical field to ensure the accuracy and integrity of the medical coding process.

They are also responsible for educating providers and staff about coding updates and new regulations.

Furthermore, they may assist in the resolution of claim denials and rejections related to coding, which involves analyzing and correcting the problematic coding and then resubmitting the claims.

Their work, therefore, contributes significantly to the financial well-being of the healthcare facility.

 

Medical Coding Quality Specialist Qualifications and Skills

A proficient Medical Coding Quality Specialist should have the skills and qualifications that align with your job description, such as:

• Knowledge of medical terminology, anatomy, and physiology to accurately code diagnoses and services.
• Excellent understanding of different coding systems like ICD-10, CPT, and HCPCS to ensure the correct codes are used.
• Exceptional attention to detail to ensure the accuracy of codes and to minimize billing errors.
• Strong analytical skills to interpret medical records and assign appropriate codes.
• Good interpersonal skills to liaise effectively with physicians, nurses, and other healthcare staff to clarify diagnoses or get additional information.
• Excellent communication skills to report findings, feedback, and education to coders and providers.
• Proficiency in using coding software and electronic health records (EHR) systems.
• Ability to stay updated on coding guidelines and reimbursement reporting requirements.
• Problem-solving abilities to identify and rectify coding errors.
• Understanding of HIPAA privacy and security laws as they relate to protected health information.

 

Medical Coding Quality Specialist Experience Requirements

Entry-level candidates for a Medical Coding Quality Specialist role generally require a minimum of 1 to 2 years of experience in medical coding.

This experience is often gained through a position in a healthcare setting such as a hospital, clinic, or health information management department.

These professionals may also gain valuable experience through internships or part-time roles related to medical coding, health information management or healthcare quality assurance.

Candidates should ideally have experience with various coding systems, such as the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT).

Candidates with more than 3 years of experience often have a broader understanding of medical coding procedures and quality control.

They may have developed their skills in roles such as Medical Coder, Coding Analyst, or Quality Assurance Analyst.

Those with more than 5 years of experience may have some leadership or training experience in their background, indicating that they are ready for a more senior role or team-lead position within the medical coding department.

In addition to job experience, many employers require Medical Coding Quality Specialists to hold specific certifications such as the Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) designation.

 

Medical Coding Quality Specialist Education and Training Requirements

A Medical Coding Quality Specialist typically requires a minimum of an associate’s degree in health information technology, medical coding, or a related field.

A bachelor’s degree in health information management could be beneficial.

These programs equip students with the necessary knowledge about medical terminology, anatomy, physiology, pathology, and pharmacology, along with the skills needed for medical coding and billing.

A Certified Professional Coder (CPC) certification is typically required, which is offered by the American Academy of Professional Coders (AAPC).

This certification reflects competence in formatting, coding, and reporting procedures.

Specialists may also need a Certified Coding Specialist (CCS) certification offered by the American Health Information Management Association (AHIMA).

CCS certification reflects higher competency in hospital-based coding.

In addition to these, a Certified Inpatient Coder (CIC) or a Certified Outpatient Coder (COC) certification can also be beneficial for specific roles.

Several years of experience in medical coding, medical billing, or a related field is typically required.

Experience with certain medical coding software may also be necessary.

Continuous education is crucial in this field to stay updated with the changing coding systems and healthcare laws.

Therefore, medical coding specialists are expected to participate in professional development activities regularly.

 

Medical Coding Quality Specialist Salary Expectations

A Medical Coding Quality Specialist can expect to earn an average salary of $57,201 (USD) per year.

The salary can vary based on factors such as experience, certifications, location, and the employing healthcare institution.

 

Medical Coding Quality Specialist Job Description FAQs

What skills does a Medical Coding Quality Specialist need?

Medical Coding Quality Specialists need strong analytical skills to understand and interpret medical records and codes accurately.

They need to be detail-oriented to ensure accuracy in the coding process.

Good communication skills are also necessary, as the job involves working with healthcare professionals and insurance companies.

Proficiency in medical coding systems and familiarity with medical terminology is essential.

 

Do Medical Coding Quality Specialists need specific qualifications?

Yes, Medical Coding Quality Specialists typically need at least an associate degree in health information technology or a related field.

Certification in medical coding, such as the Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential, is often required.

Furthermore, a thorough understanding of medical terminology, anatomy, and coding systems is essential for this role.

 

What should you look for in a Medical Coding Quality Specialist’s resume?

Look for a degree or certification in medical coding or health information management.

The candidate should also have experience in medical coding and a thorough understanding of medical terminology.

They should be proficient in using medical coding systems and software.

Knowledge of healthcare regulations and strong analytical skills are also important.

 

What qualities make a good Medical Coding Quality Specialist?

A good Medical Coding Quality Specialist is attentive to detail and maintains high accuracy in their work.

They need strong analytical skills to accurately interpret medical records and apply the appropriate codes.

They should be able to work under pressure and meet deadlines.

Good communication skills are also necessary to liaise with healthcare professionals and insurance companies.

 

What are the daily duties of a Medical Coding Quality Specialist?

On a typical day, a Medical Coding Quality Specialist reviews medical records and assigns accurate medical codes for diagnoses and procedures.

They ensure compliance with established coding guidelines and healthcare regulations.

They collaborate with healthcare providers to clarify information and resolve coding issues.

They also conduct audits to ensure coding accuracy, completeness, and adherence to quality standards.

 

Conclusion

So, there you have it.

We have just given you an insider’s view of what it truly means to be a Medical Coding Quality Specialist.

Surprise!

It’s not just about understanding medical codes.

It’s about ensuring accurate and efficient healthcare services, one medical code at a time.

Armed with our comprehensive Medical Coding Quality Specialist job description template and real-world examples, you’re ready to take your next step.

But why stop there?

Go beyond with our job description generator. It’s your essential tool for creating precise job listings or honing your resume to perfection.

Remember:

Every medical code is a part of a larger healthcare picture.

Let’s enhance the quality of healthcare. Together.

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