senior manager quality

GeBBS Healthcare Solutions


Date: 2 weeks ago
City: Aurangabad, Maharashtra
Contract type: Full time
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

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