Senior Manager Quality Medical Coding GeBBS Healthcare Solutions

5.0 - 9.0 years

0 Lacs

thane, maharashtra

On-site

You have excellent domain expertise and process knowledge about 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 the specialties of E&M-IP/OP. Your knowledge includes EM IP/OP, APC for optimizing reimbursement, UHDDS and guidelines, Level of service determination emphasizing Physical Examination & Medical Decision Making in Documentation guidelines, and hospital E&M coding for initial/subsequent visits. Additionally, you have a good understanding of Human Anatomy, Physiology, Pathophysiology, Pharmacology, Diagnostic Studies, Conservative and Surgical Treatments. You are familiar with Operative Reports and other report types along with their documentation requirements. Furthermore, you are aware of the consequences of risky practices such as up-coding and down-coding, Fraud and abuse, inflated documentation, HIPAA, and CLIA rules mandating claim transmission. As part of your responsibilities, you will supervise and manage a team of over 100 Quality Analysts. Your role includes creating an inspiring team environment with open communication, designing QA capacity planning based on project requirements, delegating tasks, and setting deadlines. You will be managing the quality of Outpatient (ED/EM/SDS/ANC/OBV), ProFee Surgery & EM, and Inpatient DRG projects in alignment with client Service Level Agreements (SLA). It is essential to ensure the effective implementation of the organization's Quality Management System, monitor team performance and metrics, and conduct random audits and Root Cause Analysis (RCA) on audit observations. You will identify knowledge gaps, develop action plans with quality leads and operation managers, discover training needs, and provide coaching to Quality Analysts. Listening to team members" feedback, resolving conflicts, recognizing high performance, rewarding accomplishments, encouraging creativity and business improvement ideas, suggesting and organizing team building activities, and identifying improvement opportunities while initiating action plans for improvement are key aspects of your role.,

Posted 1 month ago

Apply

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

Apply

Start Your Job Search Today

Browse through a variety of job opportunities tailored to your skills and preferences. Filter by location, experience, salary, and more to find your perfect fit.