Overview:
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:
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.
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
- Strong analytical and problem-solving abilities to interpret coding audit data and make data-driven decisions.
- Excellent communication skills to interact with coding staff, healthcare providers, and senior management, and to present audit findings effectively.
- 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.
Please share updated cv to kavita.aparanji@qmail.quesscorp.com
