Job Description

Knowledge: Excellent domain expertise and process knowledge (RCM for Facility/Hospital). Knowledge of ICD-10-CM, ICD-10-PCS coding guidelines, UHDDS guidelines, Principal Diagnosis, CCs and MCCs, DRG selection and validation, POS indicators, Query Process, MS DRG, APR DRG, SOI, ROM. Knowledge of medical record documentation guidelines and federal compliance guidelines in Inpatient Hospital setting. Knowledge of quality processes in Coding. Skills: Strong interpersonal, good communication, presentation, and analytical skills, quality focused and data-driven approach. Ability to manage team size of 40-50 employees. Analytical approach to problem solving. Behavior: Disciplined, positive attitude, & punctuality, team player, collaborative approach. experience must in IP DRG Coding with at least one relevant certification from AAPC or AHIMA (CCS and CIC preferred). At least 1-2 years’ experience in team management. Exposure to coding audit functions and mechanisms, developing training contents. Worked on quality improvement projects. Should have experience and understanding of coding workflows and prominent EMR(s) and CAC systems. Should be very familiar with utilization of CMS and industry guidelines for IP DRG coding. Will be responsible for supervising and managing a team of 40-50 QAs and QALs Create an inspiring team environment with an open communication culture Design QA capacity planning as per project scope requirement Delegate tasks and set deadlines Manage Quality of multiple IP DRG Coding projects Analyze internal and client quality data and suggestion remedial action plans Implement Quality control mechanisms as per client quality process Ensure effective implementation of organization’s Quality Management System Monitor team performance and report on metrics Performing random audit of auditors Perform RCA on audits observations, identify knowledge gaps, and develop an action plan with quality leads and operation managers Provider regular feedback to Training team to update content Discover training needs and provide coaching to QAs and Trainers Listen to team members’ feedback and resolve any issues or conflicts Recognize high performance and reward accomplishments