AVP - Medical coding

Overview:
Assistant Vice President coding is responsible Prepare and present reports on coding audit findings, compliance status, and performance metrics to senior management.

Ensuring accurate coding, compliance, and revenue optimization for surgical services within the organization and are responsible for leading a team of coding professionals and collaborating with other departments, such as Health Information Management, Finance, and Compliance, to ensure alignment of coding practices with organizational goals.

Qualifications:
Bachelor's degree in clinical or healthcare information management or a related field. Relevant certifications (e.g. CCS, CPC, CPMA) are mandatory.

Strong knowledge of healthcare compliance regulations and reimbursement methodologies.

Extensive experience in medical coding, with a focus on surgery coding and strong knowledge of CPT, ICD-10-CM, HCPCS coding systems.

Experience: Minimum of 15 to 19 years of progressive experience in medical coding, coding auditing, and leadership roles, preferably in a healthcare setting and minimum of 5 years' experience in surgical coding or auditing.

Working Hours: 40 HOURS PER WEEK, FULL TIME EMPLOYEE

Skills and abilities: Surgery – Ortho, IVR, GI and multispecialty.

1. Demonstrated leadership and management skills, including the ability to lead and motivate a coding audit team. Experience in specialties - Spinal procedures, Implant, GI, musculoskeletal, CABG and other cardiac procedures, IVR and Radiation oncology
2. Strong analytical and problem-solving abilities to interpret coding audit data and make data-driven decisions.
3. Excellent communication skills to interact with coding staff, healthcare providers, and senior management, and to present audit findings effectively.
4. Familiarity with health information systems and coding software tools.

ADDITIONAL AND ESSENTIAL RESPONSIBILITIES:

• Regulatory Knowledge: Strong knowledge of ICD-10-CM/PCS, CPT, coding systems, as well as a deep understanding of Medicare and Medicaid reimbursement policies.
• Provide inputs and solutions to automatically recognize and extract data from medical documents for proper coding and to facilitate auditing.
• Stay updated on changes in coding guidelines, regulations, and reimbursement policies, ensuring the organization's adherence to these standards.
• Audit Oversight: Plan, coordinate, and oversee Surgical coding audits to evaluate the accuracy and completeness of coding practices, ensuring compliance with regulatory standards
• Data Analysis: Analyze coding audit results to identify trends, patterns, and areas for improvement, and make recommendations for corrective actions.
• Quality Improvement: Develop strategies to improve coding accuracy, documentation, and compliance within the organization.
• Technology Utilization: Stay current with coding software and technology tools to improve efficiency and accuracy in the coding process.
• Reporting: Generate reports on coding and billing performance, identifying trends, and presenting recommendations for improvement to senior management.
• Prompt response to all the emails and requirements.
• Manage the day-to-day operations to meet the monthly client deliverables with agreed SLA's
• Monitor & suggest the effective utilization of resources across the project and review action plan developed to improve.
• Leading mentoring and monitoring the performance of Senior Manager to ensure efficiency in process operations.
• Review the quality metrics and checking the efficacy of quality improvement plans and sharing suggestions
• Creating and sustaining a dynamic environment that fosters development opportunities and motivates high performance amongst team members and organizing quality circle activities
• Understanding the customer pain points and provide innovative solutions to improve customer service level
• Define KRA's and assess the team performance periodically
• Identify the hiring requirement basis the volume forecast and coordinate with senior leadership and hiring team.
• Review the managers progress on operational metrics and giving the real time feedback to them
• Making sure to review the team is meeting the revenue projections on monthly basis
• Implementation of automation opportunities identified by team by coordinating with respective stake holders.
• Reviewing the daily/monthly operational reports and addressing any issues
• Ensuring Skip level meeting with immediate Reportees
• Responsible for creating SOW for new RFP and review the SOP on steady state projects
• Driving the employee engagement program for team.
• Motivating the next level layers for enrolling them in leadership program to improve their leadership skills
• Sharing inputs with senior leadership team on cost optimization
• Excellent project management skills, multi-tasking, training skills.
• Develop and lead a high-performing coding and corporate quality team aligned with organizational goals.
• Continuously ensure quality standards are met across all programs.
• Achieve recruitment objectives and ensure the team is adequately staffed.
• Support and create dynamic training schedules to accelerate the onboarding and ramp-up of new coding resources.
• Ensure full adherence to utilization targets (100%) in terms of both quantity and quality.
• Drive ongoing improvements and optimization in Coding Operations.
• Provide solutions for new client and program onboarding.
• Track and monitor key performance metrics across all stages of the process.
• Regularly report on progress, updates, and key metrics.
• Identify and analyze exceptions or anomalies and provide detailed reports.
• Analyze metrics and insights, offering comprehensive narratives and recommendations.
• Implement appropriate corrective actions and preventive measures.
• Maintain clear and effective communication throughout.

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