QA / Process Specialist - Medical Coding

TITLE :

QA / Process Specialist – Medical Coding

REPORTS TO :

General Manager - Medical Coding

DEPARTMENT :

Huron Healthcare RCM Group

WORK HOURS

: 5 days week and flexible to work in different shifts

LOCATION

: Chennai & Bangalore

SUMMARY

Responsible for the day-to-day production and quality functions of a team of coders specializing in meeting client production goals and coding accuracy goals. Help supervisor in preparing daily operational reports, provide feedback about the challenges and participates in the client interactions and internal stakeholder meetings.

Excellent communication skills, attention to detail, and strong technical and problem solving skills are essential aspects of this role.

JOB DETAILS :

Monitors performance of all coding staff using key metrics including, but not limited to daily coding volume, assignments worked, client project deadlines and coding accuracy performance to achieve and maintain a 95% coding quality accuracy rate.

Escalate Production and QA concerns or roadblocks to the Manager for involvement as needed. Work closely with the Training teams members to communicate progress across the Team to the Manager.

Reviews both production and quality accuracy reporting and / or system reports on progress for all assigned projects and share feedback

Motivates team members through effective training and coaching to improve quality and professionalism on work assignments. Conducts monthly team meetings and annual performance evaluations with team members.

Monitors and maintains team attendance records and time sheet for coders.

Completes any special projects, such as full coding audit, and other duties as assigned in a timely manner.

Mentors staff to maximize performance and potential.

Assist in maintaining and monitoring team member job satisfaction and morale.

Demonstrated domain expertise in quality process related to meeting production schedules and the coding of medical diagnoses and treatment practices

Deep understanding of both the production and quality assurance coding process and guidelines.

Analytical and problem solving skills, and the ability to use data to identify patterns and trends.

Experience providing training, coaching, and development to team members, as well as providing regular feedback regarding work performance

Must possess strong communication skills to convey information across multiple team members with varying skill sets.

Maintains a high degree of professional and ethical standards

Focuses on continuous improvement by working on projects that enable customers to arrest revenue leakage while complying with the standards.

Focuses on updating coding skills and knowledge by participating in coding team meetings and educational conferences

Extensive knowledge of coding principles and guidelines.

Extensive knowledge of hospital / technical and professional services reimbursement systems.

Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services.

Strong managerial, leadership, and interpersonal skills.

QUALIFICATIONS :

Graduate or Post Graduate in Life Science, Pharmacy, Physiotherapy, Zoology, Microbiology discipline

5+ years of industry experience

Surgery coding and auditing is mandatory.

CPC – Certified Coding Professional or

CCS - Certified Coding Specialist