Job Description

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Roles and Responsibilities: Playing an integral part of coding team and will be responsible for efficient and effective management of day to day operations. Overseeing coding activities to ensure customer service and quality expectations are met. Be the primary contact for coding questions relating to Client services and operations. Reviewing reports to identify specific issues, investigate and correct as per the coding guidelines, and implement solutions. Managing multiple tasks and creating solutions from available information. Owning challenging people and project assignments independently with ease and delivering fulfilment of work across the company. Total ownership and leadership responsibility for team development. Resource Planning based on Business volume forecasting. Continual improvement of process through regular interactions with clients. Preparing manuals, training kit and other documentations for the processes Preparing the month end reports and invoicing the clients. Evaluating the trends and comparison on month end collections for each client. Submitting the annual appraisal report by evaluating the team members on KRAs. Required Expertise & Qualification: Life Science graduation or any equivalent graduation with Anatomy/Physiology as main subjects. 8 10 years of overall coding experience, out of which a minimum 4 years in team handling of a team size ranging between 30 to 55 team members. Any one of the following coding certifications CPC, COC, CRC, CPCP from AAPC CCS, CCSP, CCA from AHIMA Excellent communication skills, both verbal and written. Strong leadership skills & Outstanding organizational skills. Hands on Experience in generating reports using MS Office Excel, word and MS power point

Job Title: Assistant Manager – Medical Coding Quality

Reports to: Quality AM

The Assistant Manager of Quality is responsible for leading a team of Quality Analysts (QAs) to ensure coding accuracy and compliance across various medical specialties. This role involves monitoring production schedules, performing high-level audits, identifying knowledge gaps through Root Cause Analysis (RCA), and implementing training programs to improve the overall quality score of the coding department.

Key Responsibilities

• Team Leadership: Manage and mentor a team of 15–30+ Quality Analysts. Conduct performance appraisals, set clear KPIs, and foster a culture of continuous improvement.
• Audit Management: Plan and execute daily, weekly, and monthly audit schedules. Review complex cases (e.g., ED FACILITY & ProFee, or ED) to ensure correct assignment of ICD-10-CM, CPT, and HCPCS codes.
• Root Cause Analysis (RCA): Analyse audit findings to identify recurring errors. Perform RCAs to determine if errors are due to documentation gaps, system issues, or coder knowledge deficits.
• Training & Education: Collaborate with the training department to develop corrective action plans (CAPs). Provide one-on-one coaching to "outlier" coders who fall below quality benchmarks.
• Compliance & Regulatory Oversight: Ensure all coding practices comply with CMS guidelines, HIPAA regulations, and NCD/LCD policies. Stay updated on annual coding changes (e.g., October ICD-10 updates).
• Client Relationship Management: Act as a point of contact for clients regarding quality concerns. Prepare and present quality reports, trend analyses, and SLA (Service Level Agreement) performance metrics.
• Process Improvement: Identify inefficiencies in the coding workflow and recommend system or procedural enhancements to boost accuracy and Turnaround Time (TAT).

3. Required Qualifications

• Education: Bachelor’s degree in Life Sciences, or a related field.
• Certification (Mandatory): Active certification from AAPC (e.g., CPC, CPMA, CIC, COC) or AHIMA (e.g., CCS, CCS-P, RHIA, RHIT).
• Experience:
  • Minimum of 6–8 years in medical coding.
  • At least 2–3 years in a leadership role (Team Lead or Senior Quality Analyst).
  • Specific expertise in the required specialty (e.g., Inpatient DRG, Surgery, or Emergency Room).

4. Essential Skills

• Technical Expertise: Mastery of CPT, ICD-10, and HCPCS coding conventions and anatomical/medical terminology.
• Analytical Skills: Ability to interpret complex data sets and recognize trends in coding denials or inaccuracies.
• Communication: Strong verbal and written skills for reporting to stakeholders and providing feedback to staff.
• Software Proficiency: Experience with Encoders (e.g., 3M), Electronic Health Records (EHR) like Epic or Cerner, and advanced MS Excel (Pivot tables, VLOOKUPs).

5. Key Performance Indicators (KPIs)

• Quality Score: Maintaining a departmental accuracy rate (typically 95% or higher).
• Audit Turnaround Time: Ensuring audits are completed within the stipulated client window.
• Denial Rate Reduction: Successfully lowering the percentage of claims denied due to coding errors.
• Team Retention: Maintaining low attrition rates within the QA team.

Ideal Candidate Profile

The ideal candidate is a "working manager"—someone who isn't afraid to dive into a complex medical record to settle a coding dispute but also possesses the soft skills needed to manage a large, diverse team. They must be detail-oriented, highly organized, and able to work under the pressure of tight revenue cycle deadlines.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.