Manager Quality Medical Coding

Job Description: As an experienced professional with domain expertise in Revenue Cycle Management (RCM) for Hospital facilities and Physicians, you will be expected to possess a deep understanding of various specialties such as E&M-IP/OP coding. Your knowledge should extend to EM IP/OP, APC for optimizing reimbursement, UHDDS and guidelines, as well as Level of service determination focusing on Physical Examination & Medical Decision Making in Documentation guidelines. Additionally, you should be familiar with hospital E&M coding - initial/subsequent visits, Human Anatomy, Physiology, Pathophysiology, Pharmacology, Diagnostic Studies, Conservative and Surgical Treatments, Operative Reports, and other relevant documentation requirements. It is crucial for you to be aware of the consequences of risky practices like up-coding, down-coding, Fraud and abuse, inflated documentation, as well as HIPAA and CLIA rules mandating claim transmission. Key Responsibilities: - Supervise and manage a team of 100+ Quality Analysts (QAs). - Create an inspiring team environment fostering open communication. - Design QA capacity planning based on project requirements. - Delegate tasks, set deadlines, and ensure quality control for OP (ED/EM/SDS/ANC/OBV), ProFee Surgery & EM, and IP DRG projects as per client SLA. - Implement the organization's Quality Management System effectively. - Monitor team performance, report on metrics, and conduct random audits of auditors. - Perform Root Cause Analysis (RCA) on audit observations, identify knowledge gaps, and develop action plans with quality leads and operation managers. - Identify training needs, provide coaching to QAs, and resolve any conflicts within the team. - Recognize high performance, reward accomplishments, and encourage creativity and business improvement suggestions. - Suggest and organize team-building activities to enhance team cohesion. - Identify improvement opportunities and initiate action plans for continuous enhancement. Qualifications Required: - Excellent domain expertise in Revenue Cycle Management for Hospital facilities and Physicians. - In-depth knowledge of specialties like E&M-IP/OP coding. - Familiarity with EM IP/OP, APC, UHDDS, guidelines, and Level of service determination. - Proficiency in Human Anatomy, Physiology, Pathophysiology, Pharmacology, and Diagnostic Studies. - Understanding of risky practices like up-coding, down-coding, Fraud and abuse, HIPAA, and CLIA rules. - Experience in supervising and managing a team of QAs. - Strong communication, leadership, and problem-solving skills.,