Medical Coder

Job Title: Medical Coding - Ancillary (Pathology, EM Primary Care, Preventive Visits, Urgent Care) QA Lead

Location: Bangalore / Chennai

Position Type: Full-Time

Experience Required: 5+ Years

Certification: CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) - Mandatory

Job Summary:

We are seeking a highly skilled and experienced Medical Coding QA Lead with specialization in Ancillary services, including Pathology, EM Primary Care, Preventive Visits, and Urgent Care. The ideal candidate will have over 5 years of industry experience, a strong understanding of medical coding guidelines, and hands-on experience in quality assurance processes. This role involves managing a team of coders, ensuring that client production and coding accuracy goals are met, and contributing to continuous improvement initiatives.

Key Responsibilities:

Quality Assurance Oversight:

• Monitor the performance of all coding staff using key metrics such as daily coding volume, assignment completion, client project deadlines, and coding accuracy to achieve and maintain a 95% coding quality accuracy rate.
• Review production and quality accuracy reports to assess progress on assigned projects and provide actionable feedback.
• Escalate production and QA concerns or roadblocks to the Manager as needed, ensuring timely resolution.

Team Leadership and Development:

• Motivate and mentor team members through effective training, coaching, and continuous professional development to enhance quality and professionalism in work assignments.
• Conduct monthly team meetings and annual performance evaluations with team members.
• Assist in maintaining and monitoring team member job satisfaction and morale, fostering a positive work environment.

Operational Support:

• Help the supervisor in preparing daily operational reports and participate in client interactions and internal stakeholder meetings to communicate progress and address challenges.
• Monitor and maintain attendance records and timesheets for coding staff.
• Complete special projects, such as full coding audits, and other duties as assigned in a timely manner.

Domain Expertise:

• Demonstrate deep understanding of both the production and quality assurance coding processes and guidelines in Ancillary-Pathology and EM Surgery coding.
• Utilize analytical and problem-solving skills to identify patterns and trends through data analysis, driving continuous improvement initiatives.
• Stay updated on coding skills and industry knowledge by participating in coding team meetings and educational conferences.

Compliance and Regulatory Knowledge:

• Maintain extensive knowledge of coding principles, hospital/technical and professional services reimbursement systems, and federal, state, and payer-specific regulations and policies related to documentation, coding, and billing for professional and technical services.
• Ensure that all coding practices adhere to professional and ethical standards and compliance requirements, focusing on reducing revenue leakage for clients while maintaining high-quality standards.

Qualifications:

• Education: Graduate or Post Graduate in Life Science, Pharmacy, Physiotherapy, Zoology, Microbiology, or a related discipline.
• Experience: Minimum of 5 years of industry experience in medical coding with a focus on Ancillary services (Pathology, EM Primary Care, Preventive Visits, Urgent Care).
• Certification: CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification is mandatory.
• Skills:
• Strong managerial, leadership, and interpersonal skills.
• Excellent communication skills with the ability to convey information effectively across a team with varying skill sets.
• High attention to detail and strong technical and problem-solving abilities.
• Ability to use data to identify patterns and trends, driving continuous improvement in coding quality and accuracy.