GeBBS is an ISO 9001 certified healthcare outsourcing solutions firm based in Englewood Cliffs, NJ, with multiple Global Delivery Centers located in Mumbai, India. We focus on providing Business Process Outsourcing (BPO) solutions to Healthcare Providers (Medical Billing companies, Hospitals, Faculty Practices and Large Physician groups). We help our clients succeed by leveraging on our domain expertise and our innovative and cost effective approach to global outsourcing.
Post : Senior Manager Quality - Medical Coding
Job Description :
Competency 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 - ED Facility/Hospital E&M, Inpatient DRG/Same Day Surgery/Observation/Profee Surgery (Cardiovascular) and Ancillary/Recurring Therapy.
• Knowledge of IP DRG/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 200+ 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 organizations 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
Additional Information
Qualification : Any Graduate
Location : Mumbai / Aurangabad
Industry Type : Pharma/ Healthcare / Clinical research
Functional Area : Medical Coding
End Date : 31st March, 2023
Interested and want to know more about the role , request you to please share your resume along with the following details on anandi.bandekar@gebbs.com
Exp:
Current ctc
Expected ctc
Notice Period
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