Senior Manager Quality Coding

4 weeks ago

Aurangabad India GeBBS Healthcare Solutions Full time

Job Description

JOB Description

Designation/Role: Manager Senior Manager IP DRG / Outpatient Coding

Department: Quality

Reporting to: Director - Quality

Location of work: Aurangabad

Knowledge

- 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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