Manager Quality Medical Coding GeBBS Healthcare Solutions

5.0 - 9.0 years

0 Lacs

maharashtra

On-site

As an individual with excellent domain expertise and process knowledge in Revenue Cycle Management (RCM) for Hospital facilities and Physicians, you possess a deep understanding of the differences between Facility hospital and Physician coding, particularly in specialties such as E&M-IP/OP. Your knowledge extends to EM IP/OP, APC optimization for reimbursement, UHDDS and guidelines, Level of service determination, Physical Examination & Medical Decision Making in Documentation guidelines, as well as hospital E&M coding for initial and subsequent visits. Your proficiency also includes a solid grasp of Human Anatomy, Physiology, Pathophysiology, Pharmacology, Diagnostic Studies, Conservative and Surgical Treatments, Operative Reports, and other report types with their respective documentation requirements. In addition, you are well-versed in the potential consequences of risky practices like up-coding, down-coding, Fraud and abuse, inflated documentation, as well as compliance with HIPAA and CLIA rules related to claim transmission. Your responsibilities will include supervising and managing a team of over 100 Quality Analysts, creating a motivating team environment with effective communication channels, designing QA capacity planning in alignment with project requirements, delegating tasks and establishing deadlines, overseeing the Quality of OP (ED/EM/SDS/ANC/OBV), ProFee Surgery & EM, and IP DRG projects, ensuring quality control compliance with client Service Level Agreements (SLA), implementing the organization's Quality Management System, monitoring team performance metrics, conducting random audits of auditors, performing Root Cause Analysis (RCA) on audit observations to identify knowledge gaps, developing action plans with quality leads and operation managers, identifying training needs and providing coaching to Quality Analysts, resolving team conflicts and issues based on feedback, acknowledging high performance and rewarding accomplishments, fostering creativity and business improvement ideas, suggesting and organizing team-building activities, as well as identifying improvement opportunities and initiating action plans for enhancement.,

Posted 1 month ago

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