Senior Manager Quality Medical Coding

Knowledge

• Excellent domain expertise and process knowledge about RCM for Hospital facility / Physician.
• Understanding of Facility hospital verses Physician coding with indepth knowledge of the specialties - E&M-IP / OP.
• Knowledge of EM – IP / OP, APC for optimizing the reimbursement and element of UHDDS and guidelines, Level of service determination with emphasis on Physical Examination & Medical Decision Making in Documentation guidelines, hospital E&M coding - initial / subsequent visit
• Good knowledge of Human Anatomy, Physiology, Pathophysiology, Pharmacology, Diagnostic Studies, Conservative and Surgical Treatments. Understanding of Operative Reports and other report types with documentation requirements.
• Aware of consequences of risky practices like up-coding and down-coding, Fraud and abuse, inflated documentation, HIPAA and CLIA rules mandating claim transmission.

Responsibilities

Skills Required

Physiology, human anatomy, Pharmacology, pathophysiology