AVP / Senior Director - Service Quality

About Access Healthcare:

Access Healthcare is a leading provider of healthcare business process outsourcing solutions, specializing in revenue cycle management, medical coding, billing, and other support services for healthcare providers worldwide. Headquartered in Dallas, Texas, with significant operations in Chennai, India, the company combines technology and expert resources to streamline administrative processes, improve financial outcomes, and enhance patient care. Access Healthcare aims to support healthcare organizations in delivering better care by taking care of their operational needs efficiently and effectively.

Eligibility Criteria:

• 18+ years of experience in Healthcare RCM, Risk Adjustment (HCC) Coding, and Quality Assurance.
• Minimum 5-6 years of Core HCC Coding experience and 15 years experience in Service Quality (Quality Assurance/Transactional quality).
• Deep knowledge of ICD-10-CM, CMS-HCC Model, Medicare Advantage, and Risk Adjustment Guidelines.
• Strong experience in HCC audit frameworks, accuracy improvement, and compliance enforcement.
• Certified in AAPC or AHIMA certifications (CRC, CPC, CCS, RHIT, or RHIA preferred).
• Expertise in AI-powered coding audit tools, automation, and process digitization is a plus.
• Strong leadership and stakeholder management experience, with the ability to influence change and drive quality initiatives.
• Data-driven mindset with experience in Quality Metrics, Root Cause Analysis (RCA), and Lean Six Sigma methodologies.

Competency Requirement (Technical & Behavioral):

Quality Assurance & Compliance

• Oversee end-to-end quality audits for HCC coding across multiple vendors and in-house teams.
• Ensure 100% compliance with CMS Risk Adjustment guidelines, ICD-10 coding standards, and HIPAA regulations.
• Implement and enforce HCC coding best practices to minimize missed diagnoses, over-coding, and under-coding.
• Lead external and internal audit programs to improve accuracy and compliance.

Process Optimization & Error Reduction

• Establish and enhance quality control frameworks to improve coding accuracy and efficiency.
• Drive initiatives to reduce error rates, improve coding precision, and enhance productivity.
• Implement AI-driven audit solutions (e.g., automated coding reviews, real-time QA tools) to optimize efficiency.
• Monitor HCC Accuracy KPIs (Missed Error Rate, Extra Error Rate, Inter-Rater Reliability).

Data-Driven Insights & Performance Improvement

• Utilize data analytics to identify trends in HCC coding accuracy, compliance risks, and vendor performance.
• Develop dashboards and reporting mechanisms for leadership visibility on quality performance metrics.
• Collaborate with Operations & Training teams to address coding discrepancies and drive corrective action plans.

Team Leadership & Training

• Lead and mentor a team of QA Managers, Auditors, and Trainers across multiple locations.
• Develop quality training programs for coders to enhance their proficiency and ensure coding consistency.
• Foster a culture of continuous improvement, compliance, and performance excellence.

Interested candidates with the above mentioned experience, please share your updated resume to jerlinbetsy.m@accesshealthcare.com