Job Description

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 • 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