Job
Description
As an experienced professional in Revenue Cycle Management (RCM) for Hospital facility/Physician, you possess excellent domain expertise and process knowledge. Your understanding of Facility hospital versus Physician coding, along with in-depth knowledge of specialties such as E&M-IP/OP, will be crucial in optimizing reimbursement. Your familiarity with EM IP/OP, APC, UHDDS guidelines, and Level of service determination will ensure accurate coding and adherence to documentation guidelines. Additionally, your knowledge of Human Anatomy, Physiology, Pathophysiology, Pharmacology, and various treatments will be essential in interpreting Operative Reports and complying with documentation requirements. You are well-versed in the consequences of risky practices like up-coding and down-coding, Fraud and abuse, inflated documentation, as well as HIPAA and CLIA rules governing claim transmission. Your responsibilities in this role will include: - Supervising and managing a team of 100+ Quality Analysts - Creating a motivating team environment with open communication - Designing QA capacity planning based on project requirements - Delegating tasks, setting deadlines, and ensuring quality control as per client SLA - Implementing the organization's Quality Management System effectively - Monitoring team performance, reporting metrics, and conducting random audits - Performing Root Cause Analysis (RCA) on audit observations, identifying knowledge gaps, and developing action plans with quality leads and operation managers - Identifying training needs, providing coaching to QAs, and resolving conflicts - Recognizing high performance, rewarding accomplishments, and fostering creativity and business improvement ideas - Suggesting and organizing team-building activities and initiating action plans for improvement opportunities. Your role will be instrumental in ensuring the efficiency and effectiveness of the Revenue Cycle Management processes within the organization. As an experienced professional in Revenue Cycle Management (RCM) for Hospital facility/Physician, you possess excellent domain expertise and process knowledge. Your understanding of Facility hospital versus Physician coding, along with in-depth knowledge of specialties such as E&M-IP/OP, will be crucial in optimizing reimbursement. Your familiarity with EM IP/OP, APC, UHDDS guidelines, and Level of service determination will ensure accurate coding and adherence to documentation guidelines. Additionally, your knowledge of Human Anatomy, Physiology, Pathophysiology, Pharmacology, and various treatments will be essential in interpreting Operative Reports and complying with documentation requirements. You are well-versed in the consequences of risky practices like up-coding and down-coding, Fraud and abuse, inflated documentation, as well as HIPAA and CLIA rules governing claim transmission. Your responsibilities in this role will include: - Supervising and managing a team of 100+ Quality Analysts - Creating a motivating team environment with open communication - Designing QA capacity planning based on project requirements - Delegating tasks, setting deadlines, and ensuring quality control as per client SLA - Implementing the organization's Quality Management System effectively - Monitoring team performance, reporting metrics, and conducting random audits - Performing Root Cause Analysis (RCA) on audit observations, identifying knowledge gaps, and developing action plans with quality leads and operation managers - Identifying training needs, providing coaching to QAs, and resolving conflicts - Recognizing high performance, rewarding accomplishments, and fostering creativity and business improvement ideas - Suggesting and organizing team-building activities and initiating action plans for improvement opportunities. Your role will be instrumental in ensuring the efficiency and effectiveness of the Revenue Cycle Management processes within the organization.
