Job Title: Quality Manager Medical Coding
Location: Aurangabad
Work Mode: Work from Office
Role Overview
The
Quality Manager (Medical Coding) will be responsible for leading and managing a large QA team, ensuring high-quality coding delivery across Hospital Facility and Physician domains. This role demands strong domain expertise in RCM processes, a deep understanding of coding standards, and the ability to drive quality improvement initiatives aligned with organizational goals.
Domain Expertise & Knowledge Requirements
- In-depth understanding of RCM processes for both Hospital Facility and Physician settings.
- Excellent knowledge of E&M IP/OP and APC for optimizing reimbursement, along with familiarity with UHDDS guidelines.
- Proficient in Level of Service (LOS) determination, including Physical Examination and Medical Decision-Making documentation guidelines.
- Expertise in Hospital E&M Coding Initial/Subsequent Visits.
- Strong foundation in Human Anatomy, Physiology, Pathophysiology, Pharmacology, and Diagnostic Studies.
- Skilled in interpreting Operative Reports and understanding documentation requirements for both conservative and surgical treatments.
- Awareness of compliance and ethical standards including upcoding/downcoding risks, fraud and abuse prevention, HIPAA, and CLIA regulations.
Key Responsibilities
- Supervise and manage a team of 100+ Quality Analysts (QAs) across multiple RCM projects.
- Create an open and inspiring team culture that encourages communication and collaboration.
- Design and execute QA capacity planning based on project requirements.
- Delegate tasks effectively, define deadlines, and ensure timely delivery of quality outputs.
- Oversee quality control for OP (ED/EM/SDS/ANC/OBV), ProFee Surgery & EM, and IP DRG projects.
- Ensure adherence to client SLAs and organizational quality standards.
- Conduct random audits of auditor performance to maintain objectivity and accuracy.
- Perform Root Cause Analysis (RCA) on audit observations; identify knowledge gaps and create corrective action plans in collaboration with Quality Leads and Operations Managers.
- Identify training needs and provide coaching to enhance QA team capabilities.
- Address team issues or conflicts promptly and constructively.
- Recognize and reward high performance and contributions.
- Encourage creativity, process improvement, and business innovation.
- Plan and execute team-building activities to strengthen collaboration and engagement.
- Identify continuous improvement opportunities and implement effective action plans.
