Manager Quality Medical Coding

1 hour ago

Aurangabad, Maharashtra, India Gebbs Healthcare Solutions Full time

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.

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