91 Quality Assurance Roles jobs in the Philippines

The Quality Analyst - Medical Coder role is a specialized position focused on ensuring the accuracy and compliance of medical coding processes, with an emphasis on Evaluation and Management (E&M) coding for outpatient, inpatient, observation, and critical care facilities. This role requires a strong foundation in medical coding standards, exceptional attention to detail, and the ability to work independently while maintaining high-quality standards. The position is based onsite in Taguig, operating on a morning shift schedule, and requires adaptability to meet regulatory requirements and deadlines.

Key responsibilities include performing audits to verify the accuracy of ICD-10, CPT-4, HCPCS, and Modifier assignments, as well as reviewing claims that have been denied or rejected due to coding, documentation, or clinical validation issues. You will prepare detailed reports for management review, identifying trends and providing actionable insights. The role involves conducting focused retrospective audits and regular scheduled audits of individual coders to ensure compliance and accuracy. You will also manage audits conducted by internal and external entities, responding to requests for code verification promptly and accurately.

In collaboration with Coding Supervisors and the Coding Manager, you will contribute to the development of educational and training opportunities for staff, enhancing the team’s coding proficiency and adherence to best practices. The role requires clear written and verbal communication to present audit results, provide feedback, and maintain positive relationships with internal and external teams and customers. You will need to work independently with minimal supervision, meet deadlines, and adapt to frequent changes in regulations while maintaining a high level of professionalism.

To succeed, candidates must have a bachelor’s degree in a life sciences field such as Physiotherapy, Pharmacy, Nursing, or Biosciences, with Anatomy or Physiology as a subject. A minimum of 3 years of experience in E&M inpatient and/or outpatient medical record review, coding, and reimbursement is required, with coding audit experience preferred. Candidates must hold a Certified Professional Coder (CPC) credential from the American Academy of Professional Coders (AAPC) or a Certified Coding Specialist (CCS) credential from the American Health Information Management Association (AHIMA) prior to hire. Additional certifications such as RHIA or RHIT are preferred but not mandatory.

Strong knowledge of ICD-10-CM/PCS and CPT coding, as well as prospective

Designation

Quality Analyst

Subordinate

Team Leader

Job Level

Intermediate

Department

Medical Billing/AR

Reporting to

Senior Operations Manager

PURPOSE OF THE POSITION

The Quality Analyst (QA) in the Healthcare Accounts Receivable (AR) and Medical Billing team plays a critical role in maintaining service excellence by ensuring compliance with billing standards, payer guidelines, and internal processes.

The QA monitors work quality, provides actionable feedback, and partners with operations and training teams to drive performance improvements and reduce error rates. This role serves as a key checkpoint in the quality lifecycleensuring claims are handled accurately and efficiently, supporting timely revenue recovery for our clients.

RESPONSIBILITIES

• Audit a daily sample of billers' case transcripts.

• Document audit results in a standardized tracker and ensure 

  completeness and consistency of findings.
• Identify patterns and recurring errors from audit results and escalate major discrepancies or compliance risks to Team Leads or Ops Managers.

• Collaborate with TLs and Trainers to align on recurring issues and plan targeted coaching or refresher training sessions.

• Support calibration sessions to maintain scoring alignment with 

  client and operational leads.

• Provide clear and structured feedback to specialists based on audit results.

• Handle QA-related inquiries, audit appeals, validate audit logic, 

  and update feedback if necessary.

• Generate and analyze daily, weekly, or ad hoc QA reports to provide insights on team quality trends and process bottlenecks.

• Flag outliers, productivity-to-quality gaps, and compliance risks in collaboration with Operations and Training.

• Prepare QA summaries for client-facing decks and internal reviews as needed.

• Partner with Trainers and Operations to conduct joint root cause analysis and process refinement.

• Participate in internal syncs, updates, or policy briefings to stay aligned with client expectations.

• Support internal and external calibration sessions and provide QA representation in client or compliance reviews.

JOB REQUIREMENT

• Fluent in English (C1 level or above), with strong communication and leadership skills.
• Excellent verbal and written communication skills in English, with the ability to express ideas clearly and concisely.
• Be detail-oriented with strong analytical skills; Proficient skills with MS Office and Google Drive.
• Minimum of 1 year experience in healthcare AR, revenue cycle, or medical billing, with at least 1 year in a leadership role (external candidate).
• In-depth knowledge of billing practices, payer guidelines, denial management, and compliance standards (e.g., HIPAA).
• Strong analytical, decision-making, and problem-solving skills.
• Comfortable using billing systems, claim portals, and productivity monitoring tools.
• Ability to thrive in a fast-paced, client-driven environment.
• Able to work on Holidays is preferable.