Manager - Medical Coding(US Healthcare)

Designation: Manager - Medical Coding

Work Mode : Work from Office

Shift Timings : 6.30 pm to 3.30 am IST

Location : Ganapathy, Coimbatore

Position Overview: We are seeking a skilled and experienced individual to join our team as a Medical Coding Manager. The ideal candidate will possess a deep understanding of medical coding principles, regulations, and industry standards. They will be responsible for overseeing the coding operations, ensuring accuracy, compliance, and efficiency in all coding processes.

Role Prerequisites:

• Minimum of 6 years of experience in the Medical coding domain is a must
• Currently working for a min of 3 years at least as SME, Team Lead, Team Coach or Team Manager is a must
• Should have experience of Team Management of upto 10 members.
• BPT, MPT, BSC Nursing, MSC Nursing, B Pharm, M Pharm, BOT, Life Science is preferred.
• AHIMA/AAPC/CCA/CPC/CCS certification is a must
• MBBS, BDS, BAMS, BHMS, BUMS etc would be an added advantage
• Should be conversant with core coding guidelines and best practices with strong knowledge of NCCI edits, local and national policies (CMS guidelines)
• In-depth knowledge of medical coding principles, including ICD-10, CPT, HCPCS, and DRG systems.
• Familiarity with electronic health record (EHR) systems and coding software applications
• Familiarity with coding software systems, such as 3M Encoder, Optum360 Encoder, or TruCode
• Attention to detail and accuracy in assigning codes and reviewing medical documentation
• Good Knowledge of Microsoft Excel and PPT

Key Responsibilities:

Process:

• Responsible for the day to day planning as well as work allocation for the entire team
• Ensuring regular as well as on time floor and knowledge support for all the team members
• Develop / maintain monthly coding production and accuracy reports to track and optimize internal productivity & quality improvement activities
• Creating and Implementing SOPs
• Ensure all coder/specialist performance data is maintained and shared as and when required
• Accountable for client delivery SLAs including meeting turnaround time (TAT), daily/weekly/monthly volume deliverables and Quality
• Partner with the recruitment team in the hiring efforts of OPX Global.
• Stay up-to-date on changes in healthcare regulations, coding guidelines, and reimbursement policies to ensure compliance and accuracy.

People:

• Accountable for overall performance of the team as well as people metrics such as attrition (retention), absenteeism, schedule adherence, TOS
• Ensuring upskilling of team members through constant coaching and feedback, execution of individual development plans and completion of performance appraisals on time
• Ensuring high engagement levels in the team through various ESAT initiatives such as huddles, team meetings and EMPOWER connects
• Train the team on the latest updates in regards to coding and documentation. Work with training and quality team members to make sure there is ongoing training for the team based on feedback from quality
• Train the coders on various client specifications
• Responsible for understanding people's concerns and coordinating with required stakeholders for solution and escalate/highlight for any support required from PL
• Define career paths and development goals for every individual in the team
• Ensuring a Learning culture through constant training needs identification, training program coverage at all levels as per development plans for his/her account/department designed in the Career Architecture
• Ensuring that all programs planned for Self Development are completed

Client:

• Identify areas for provider education and prepare notes
• Responsible for all client reports including report cards, production report and quality report
• Responsible for all client workflows, reconciliation and closure
• Responsible for bringing any clarifications to client and get it resolved and guide the team based on the response
• Lead scheduled client calls on agenda as well document MOM
• Assist PL on MBR, QBRs for performance presentations and agenda items, follow up action items and closure
• Responsible for addressing all client concerns, issues at 1st level along with closing the loop to client
• Responsible for responding to all client emails in a timely manner (ideally within 24 hrs)
• Custodian of process SOP and own the update management and sign off from client
• Accountable for delivering service as per client SLA including meeting TAT, volumes and quality

Financial:

• Responsible for driving the topliner of P&L - Volumes for transactional model and resources and productivity on FTE model
• Take initiatives on any revenue uplift by processing additional volumes without increasing resources/cost
• Primarily assist on driving all efficiency measures at team level along with PL for cost efficiency
• Assist PL on keeping the right mix of resources from cost perspective