Quality Manager Medical Coding

10 - 15 years

15 - 25 Lacs

Posted:Just now| Platform: Naukri logo

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Job Type

Full Time

Job Description

The Quality Manager - Medical Coding will oversee and lead the Quality Assurance (QA) team to ensure coding accuracy, regulatory compliance, and adherence to client SLAs across multiple RCM projects. This role requires strong leadership, deep domain expertise in Hospital Facility and Professional (Physician) Coding, and a strategic mindset to drive continuous improvement and team development.

Key Responsibilities

Team Leadership & People Management

  • Lead and manage a team of 100+ Quality Analysts across diverse RCM coding projects.
  • Foster an inspiring and collaborative team environment with open communication.
  • Plan and allocate QA capacity based on workload and project needs.
  • Delegate responsibilities, establish clear timelines, and monitor performance.
  • Coach, train, mentor, and guide QAs to enhance competency and productivity.
  • Address team concerns, resolve conflicts, and ensure a healthy work environment.
  • Recognize and reward high-performing team members.
Quality Assurance & Compliance
  • Ensure high-quality coding delivery aligned with client SLAs and industry guidelines.
  • Implement and enhance the Quality Management System (QMS).
  • Conduct regular quality reviews, including random audits of auditors.
  • Perform root cause analysis (RCA) on audit findings and implement corrective actions.
  • Identify knowledge gaps and drive structured action plans with Quality Leads & Operations.
  • Monitor and publish performance metrics, KPIs, and quality trends.
Process Excellence & Continuous Improvement
  • Identify opportunities for process improvement and workflow optimization.
  • Encourage innovation, automation, and best practices within the QA team.
  • Collaborate with cross-functional leaders to strengthen quality delivery and compliance.
Competency & Knowledge Requirements
  • Strong expertise in RCM coding for

    Hospital Facility

    and

    Physician (Professional) Coding.

  • In-depth knowledge of

    E&M, ED, Surgery, IVR

    , and

    UHDDS

    guidelines.
  • Comprehensive understanding of

    Anatomy, Physiology, Pathophysiology, Pharmacology,

    and

    clinical documentation.

  • Ability to interpret

    Operative Reports, ED charts, Surgery records,

    and

    complex documentation.

  • Strong understanding of compliance risks:

    upcoding, downcoding, fraud/abuse, documentation inflation, HIPAA, CLIA.

  • Excellent communication skills, analytical ability, and team-handling skills.
  • Proficient in coding guidelines and audit methodologies.
  • Preferred:

    Certified Professional Coder (e.g., CPC, CCS, CIC, COC, CCS-P).

Additional Details

Notice Period:

Salary:

Skills:

Our Culture & Values

At Calpion, were not just a company were a dynamic culture fueled by six core values: Agile, Collaborative, Innovative, Fun, Inclusive, and Passionate. These values drive our every move:

  • Agile:

    We thrive on change, adapting swiftly to new challenges.
  • Collaborative:

    Together, we achieve greatness through teamwork and diverse perspectives.
  • Innovative:

    We push boundaries, constantly exploring new ideas and solutions.
  • Fun:

    Laughter and camaraderie make our workplace a joyous one.
  • Inclusive:

    Diversity is our strength, ensuring every voice is heard and valued.
  • Passionate:

    We approach every task with dedication and enthusiasm.

Join us at Calpion and be part of a culture thats not just about work but innovation, growth, and making an impact.

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