Job Description

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 - EM-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 EM 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 Will be responsible for supervising and managing a team of 100+ QAs Create an inspiring team environment with an open communication culture Design QA capacity planning as per project requirement Delegate tasks and set deadlines Manage Quality of OP (ED/EM/SDS/ANC/OBV), ProFee Surgery EM, and IP DRG projects Quality control as per client SLA Ensure effective implementation of organization s Quality Management System Monitor team performance and report on metrics Performing random audit of auditor Perform RCA on audits observations. Identify knowledge gaps and develop an action plan with quality leads and operation managers Discover training needs and provide coaching to QAs Listen to team members feedback and resolve any issues or conflicts Recognize high performance and reward accomplishments Encourage creativity and business improvement ideas Suggest and organize team building activities Identify improvement opportunities and initiate action plans for improvement