Senior Manager Quality

As a candidate for this position, you should possess excellent domain expertise and process knowledge about RCM for Hospital facility/Physician. Your understanding of Facility hospital verses Physician coding with in-depth knowledge of specialties such as E&M-IP/OP will be crucial. It is important for you to have knowledge of EM IP/OP, APC for optimizing reimbursement, UHDDS and guidelines, Level of service determination, and emphasis on Physical Examination & Medical Decision Making in Documentation guidelines. Additionally, your knowledge should extend to hospital E&M coding - initial/subsequent visit. Familiarity with Human Anatomy, Physiology, Pathophysiology, Pharmacology, Diagnostic Studies, Conservative and Surgical Treatments is required. Understanding Operative Reports and other report types with documentation requirements is a key aspect. You should also be aware of consequences of risky practices like up-coding and down-coding, Fraud and abuse, inflated documentation, HIPAA, and CLIA rules mandating claim transmission. Your responsibilities in this role will include: - Supervising and managing a team of 100+ QAs. - Creating an inspiring team environment with an open communication culture. - Designing QA capacity planning as per project requirements. - Delegating tasks and setting deadlines. - Managing Quality of OP (ED/EM/SDS/ANC/OBV), ProFee Surgery & EM, and IP DRG projects. - Ensuring quality control as per client SLA. - Effective implementation of the organization's Quality Management System. - Monitoring team performance and reporting on metrics. - Performing random audits of auditors. - Performing RCA on audit observations to identify knowledge gaps and develop action plans with quality leads and operation managers. - Discovering training needs and providing coaching to QAs. - Listening to team members" feedback and resolving any issues or conflicts. - Recognizing high performance and rewarding accomplishments. - Encouraging creativity and business improvement ideas. - Suggesting and organizing team-building activities. - Identifying improvement opportunities and initiating action plans for improvement.,