Competency Knowledge: Excellent domain expertise and process knowledge about RCM for Hospital Facility Outpatient Coding, Physician Profee Coding, ED Profee and Facility, EM, Outpatient. Understanding of Physician Profee coding with in-depth knowledge of the applicable specialties and domain area(s) - ED, EM, Anesthesia, Pain Management, HCC, Surgery (multiple specialties - Cardiovascular, Orthopedic, Dermatology, Ophthalmology, ENT, Physical and Rehab Therapy, Digestive, Urinary, OB-GYN , Neurospine), Coding Denials, Interventional Radiology, Surgical Pathology, and/or Radiology. Knowledge of Profee Coding for optimizing reimbursement and elements of ICD-10-CM guidelines; Procedure (CPT HCPCS) coding modifier guidelines; level of service determination with emphasis on History, Physical Examination Medical Decision Making in 2003 Documentation guidelines, hospital EM coding - initial/subsequent visit, Global Surgical Package, NCCI edits, MUE edits, LCD coverage policies. Good knowledge of Human Anatomy, Physiology, Pathophysiology, Pharmacology, Diagnostic Studies, Conservative and Surgical Treatments. Understanding of Operative Reports, Visit Notes, Diagnostic Studies and other report types with documentation requirements. Understanding of CMS and commercial insurance payment methodologies and guidelines. Aware of regulatory compliance guidelines and consequences of risky practices like up-coding and down-coding, Fraud and abuse, inflated documentation, HIPAA and CLIA rules mandating claim transmission. Skills: Strong interpersonal skills, excellent communication skills, and ability to effectively work with and train employees; both fresher and experienced. Need to communicate with operations, MIS and training for Quality Management. Possess operational skills to manage team with better resource utilization. Should have an aptitude to learn new things. Ability to read, writes, and performs basic computer operation. Must be a self -starter, highly motivated, organized and able to prioritize. Managing reports daily, weekly, monthly and monitoring and being active participant in client calls and maintaining good client relationship. Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services with excellent co-ordination with Operations Managers Ability to communicate effectively in writing, over the telephone, and in person. Proficient in MS office Behavior: Disciplined, positive attitude, punctual. Qualifications: Bachelor degree from a Life science stream (Biotech, Microbiology , Pharmacy, Physiotherapy, Zoology, Botany) or BHMS, BDS Experience Min 4-5 years coding experience in Physician Profee Coding in 1 or more areas of specialties with an AHIMA or AAPC certification. Preferably at least 2-3 years experience in a lead role with auditing, training, SME role and/or managing a team of QAs or coders. Should have hands on experience in the relevant specialty(s). Should have experience in prominent EMR(s) and Encoder(s). Should be very familiar with utilization of references from CMS sources, Coding Clinic, and CPT Assistant. Responsibilities Will be responsible for supervising and managing a team of 20-25 QAs Create an inspiring team environment with an open communication culture Design QA capacity planning Delegate tasks and set deadlines Manage Quality of ProFee EM Coding projects Quality control as per client SLA Ensure effective implementation of organization s Quality Assurance Management System Monitor team performance and report on metrics Performing random audit of auditor Perform RCA on audits observations. Identify knowledge gaps and develop an action plan with quality leads and operation managers Discover training needs and provide coaching to QAs Listen to team members feedback and resolve any issues or conflicts Recognize high performance and reward accomplishments Encourage creativity and business improvement ideas Suggest and organize team building activities Identify improvement opportunities and initiate action plans for improvement
