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Quality Assurance Specialist
5 months ago
Quality Assurance Specialist - MCC
Experience - 5 - 7 years
Regular Shift Timings / Full Time Role - Permanent
Location: Mumbai
Roles and Responsibilities:
- Possess Knowledge on Risk adjustment models - Medicare, Commercial and Medical aid.
- Should be well versed in coding standards and guidelines including ICD - 10 - CM guidelines, AHA coding clinic updates and client specific guideline requirements.
- Should be able to perform QA audits for multiple projects.
- Derive effective QA sampling and audit methodology for the projects assigned.
- Possess analytical skills to monitor and measure the quality trend in the coding projects.
- Perform root cause analysis, identify knowledge gaps, and conduct training to project team.
- Review scope document and guidelines for new clients before the start of the project and own pilot project delivery to meet client SLA on quality.
- Review and customize standard coding guidelines as needed.
- Identity error trends on client feedback and improve client experience by continuous improvements.
- Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors.
- Ability to respond to the internal coding queries with proper rationale.
- Follow external and internal compliance standards.
Required Skills:
- Medical coding experience minimum of 5 years is mandatory
- Worked at least 1 year as an SME/ QA.
- Experience in any coding specialty is preferred to handle the pilot projects.
- Risk adjustment coding experience is an added advantage.
- AAPC/ AHIMA Certification is mandatory
- Strong Knowledge in Anatomy and Physiology.