Greetings from Coronis health!
12+ Years in Medical Coding - Quality management
Role Summary
QA Manager - Medical Coding
The QA Manager will be responsible for ensuring coding accuracy, regulatory compliance, continuous process improvement, and the implementation of innovative quality strategies that enhance productivity, scalability, and client satisfaction.
Key Responsibilities
- Lead and manage the quality function for Medical Coding operations across multiple specialties.
- Develop, implement, and monitor quality assurance programs, coding audit methodologies, and performance metrics.
- Conduct periodic coding audits to ensure adherence to CPT, ICD-10-CM, HCPCS, and payer-specific guidelines.
- Analyze audit findings, identify trends, and implement corrective and preventive action plans.
- Drive continuous process improvement initiatives to enhance coding accuracy, productivity, and operational efficiency.
- Partner with Operations, Training, and Client Services teams to establish quality benchmarks and achieve service-level objectives.
- Ensure compliance with regulatory requirements, client standards, and organizational quality policies.
- Develop and maintain quality dashboards, scorecards, and key performance indicators (KPIs).
- Lead root cause analysis for quality concerns and drive sustainable solutions.
- Identify opportunities for automation, innovation, and workflow optimization to improve quality outcomes.
- Mentor, coach, and develop QA Leads, Auditors, and Coding Teams.
- Participate in client reviews, business reviews, and quality governance meetings.
- Support new transitions, process migrations, and business expansion initiatives from a quality perspective.
Required Qualifications
- Bachelor's degree in Life Sciences, Healthcare, Pharmacy, Nursing, Allied Health Sciences, or related disciplines.
- Professional certification such as
CPC, CCS, CCS-P, CRC, or equivalent
is mandatory. - 12+ years of overall Medical Coding experience with significant exposure to Quality Assurance and Auditing functions.
- Minimum 3-5 years of experience in a managerial or leadership role within Medical Coding Quality.
- Strong knowledge of ICD-10-CM, CPT, HCPCS, CMS guidelines, payer requirements, and revenue cycle processes.
- Proven experience in coding audits, quality governance, process excellence, and operational improvement initiatives.
- Excellent analytical, stakeholder management, communication, and presentation skills.
Preferred Skills
- Six Sigma, Lean, Quality Management, or Process Excellence certifications.
- Experience managing large coding teams across multiple specialties and client accounts.
- Expertise in quality metrics, reporting tools, and data-driven decision-making.
- Exposure to automation, AI-assisted coding technologies, and innovation projects.
- Strong change management and leadership capabilities.
Key Competencies
- Quality Leadership
- Coding Audit Expertise
- Process Improvement
- Innovation & Transformation
- Operational Excellence
- Compliance & Risk Management
- Stakeholder Management
- Team Development & Mentoring
- Strategic Thinking
- Data Analysis & Problem Solving
Contact person : Mahalakshmi C
