Operation Delivery Lead

Position Title: Operation Delivery Leader (Coding Quality)

Function: Coding

Location: Hyderabad

Shift Timings: 12:00 to 22:00 Hrs. (flexible)

Reporting To: Director

Responsibilities:

Lead a team of quality senior managers/managers/ assistant managers for multiple business units/customers and across locations.

Lead closer calibrated quality outcomes for end customers.

Drive customer satisfaction for quality of coding output including corrective and preventive actions for customer quality concerns.

Build and operate a predictable quality model and well aligned outcome-based quality assurance unit for coding.

Actively collaborate new customer engagements for better quality outcomes including calibration, SOP inputs

Drive the structure and governance for ongoing customer calibrations.

Collaborate and drive coding compliance reviews, alignment, and actions.

Lead quality representation in business reviews weekly, monthly, and quarterly as well customer and internal stakeholders/leadership visits.

Drive high level of visibility on business performance and measures to relevant internal stakeholders.

• Actively lead collaborative efforts and cohesive outcomes between US and Global QA teams

Drive and guide analytics for comprehensive quality dashboards along with business insights and publish for internal stakeholders and leaders

. Drive quality transformation initiatives and continual process improvement.

Create effective quality sampling process and governance.

Drive QA effectiveness and alignment with customer perceived quality.

Collaborate with product team to build and manage comprehensive QA workflow tool along with reporting and insights capabilities.

Drive process improvement initiatives including process reengineering, lean and automation initiatives to drive efficiency.

Drive value-based initiatives including upstream opportunities from AR to coding, coding denials to abstract coding as well coding optimization, benchmarking, and CDI/provider education initiatives as well technology initiatives such as autonomous coding, coding edits/scrubbers and auto fixes.

Collaborate with training team to drive effective feedback loop to address quality gaps through onboarding training.

Drive high performing quality operations with closer governance on KPIs such as productivity, absenteeism, shift adherence, utilization, productive time etc

Drive high people engagement including framework for periodical connects including 1 to 1, skips, FGDs as well use the people survey tool to drive meaningful actions, EWS and employee retention and govern attrition.

Manage all exceptions and escalations for quality team.

Drive people development efforts and framework around IDP and R&R initiatives and be an inspiring people leader

. Closely work with operations to meet dynamic business needs on quality support.

Review and govern external audits rebuttals and final outcomes.

Govern transactional quality operations as well drive strategic initiatives and implement best QA practices.

Identify process improvement/business excellence/process reengineering opportunities and drive further.

Drive automation and transformation initiatives.

Exposure to digital solutions, automation, AI and analytics and ability to implement digital solutions.

Analytical and structured approach with extensive experience in implementing high impact projects and delivering transformation projects in scale .

No of years of Experience: Minimum 18 Years of Experience in managing Multispecialty Coding in RCM/US healthcare is preferred along with understanding on Quality Concepts.

Minimum Qualification: Graduation.

Required Qualifications

• License/Certifications: Currently holds and maintains at least 1 role-related certification (CCS or CIC for inpatient roles, CPC, COC, CCS, CCS-P for outpatient roles, CPMA for auditing role).
• Additional certifications in specific specialties (CEMC, CASCC, CEDC, CGSC, CHONC, CIRCC, COBGC) are a plus.
• Experience in professional and facility coding.
• Strong knowledge of CMS guidelines, Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS), National Correct Coding Initiative (NCCI) edits, and Inpatient Prospective Payment System (IPPS).

Desired Qualifications

• Experience in RCM/US Healthcare: Preference strong domain understanding of US healthcare (Payer/Provider); Provider experience preferred. To learn more, visit:

• Excellent communication skills, presentation skills, and proficiency in MS Excel & PowerPoint.

• Education Bachelors degree in a medical allied course is preferred. For other courses, a high level of knowledge and relevant work experience to illustrate capability.

• Proficiency in medical terminologies and disease processes.
• Strong attention to detail.
• Ability to work independently and as part of a team.
• At least 1 year of experience as a quality auditor is preferred.
• Experience working with coding software such as Epic, Cerner, Meditech, and 3M 360.