Manager Quality Medical Coding

Date: 4 days ago

City: Aurangabad, Maharashtra

Contract type: Full time

Excellent domain expertise and process knowledge about RCM for Hospital facility/Physician.

Understanding of Facility hospital verses Physician coding with indepth knowledge of the specialties - E&M-IP/OP.
Knowledge of EM – IP/OP, APC for optimizing the reimbursement and element of UHDDS and guidelines, Level of service determination with emphasis on Physical Examination & Medical Decision Making in Documentation guidelines, hospital E&M coding - initial/subsequent visit
Good knowledge of Human Anatomy, Physiology, Pathophysiology, Pharmacology, Diagnostic Studies, Conservative and Surgical Treatments. Understanding of Operative Reports and other report types with documentation requirements.
Aware of consequences of risky practices like up-coding and down-coding, Fraud and abuse, inflated documentation, HIPAA and CLIA rules mandating claim transmission.

Responsibilities

Will be responsible for supervising and managing a team of 100+ QAs
Create an inspiring team environment with an open communication culture
Design QA capacity planning as per project requirement
Delegate tasks and set deadlines
Manage Quality of OP (ED/EM/SDS/ANC/OBV), ProFee Surgery & EM, and IP DRG projects
Quality control as per client SLA
Ensure effective implementation of organization’s Quality Management System
Monitor team performance and report on metrics
Performing random audit of auditor
Perform RCA on audits observations. Identify knowledge gaps and develop an action plan with quality leads and operation managers
Discover training needs and provide coaching to QAs
Listen to team members’ feedback and resolve any issues or conflicts
Recognize high performance and reward accomplishments
Encourage creativity and business improvement ideas
Suggest and organize team building activities
Identify improvement opportunities and initiate action plans for improvement

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