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.
This role bridges the gap between executive strategy and front-line execution. This role directly oversees a team of Quality Auditors, ensures strict adherence to international coding standards, and acts as the project lead for implementing automation tools, such as AI-driven Computer-Assisted Coding (CAC).
Key Responsibilities
1. Quality Assurance & Performance Management
Daily QA Operations: Manage daily workflows for the medical coding quality audit teams across multiple specialties
Accuracy Governance: Maintain and enforce transactional accuracy targets, ensuring the delivery team consistently meets or exceeds the client SLAs
Feedback Loops: Establish structured feedback mechanisms to communicate audit findings to production managers, facilitating rapid, data-driven corrective actions.
2. Process Transformation & Technology Execution
Automation Deployment: Act as the hands-on project manager for deploying autonomous coding systems, CAC software, and workflow optimization tools.
Workflow Optimization: Identify operational bottlenecks, eliminate redundancies, and apply Lean methodologies to reduce turnaround times and operational costs.
Root-Cause Analysis: Perform deep-dive denial analyses and partner with the Training & Operations to deploy targeted remediation plans.
3. Client & People Management
SLA Compliance: Monitor, analyze, and present client-specific quality metrics, serving as the primary point of contact for routine quality reviews and audit rebuttals.
Team Development: Recruit, mentor, and conduct performance appraisals for Quality Lead Auditors and Subject Matter Experts (SMEs).
Required Qualifications
Education & Certifications
Degree: Bachelor’s degree in Health Information Management (HIM), Life Sciences, Healthcare Administration, or a related field.
Core Credentials: Must hold active certifications from AAPC or AHIMA:CPC (Certified Professional Coder) / CCS (Certified Coding Specialist)CIC (Certified Inpatient Coder) / COC (Certified Outpatient Coder) is preferred
Process Certification: Lean Six Sigma Green Belt certification is highly desirable.
Experience & Skills
Domain Expertise: Minimum of 7–9 years of experience in healthcare revenue cycle management (RCM), with at least 4 years in a direct medical coding quality supervisory or management role.
Tech Literacy: Strong operational experience working with major EHRs (Epic, Cerner), encoder software (3M), and automated billing/coding platforms.
Leadership Scope: Proven track record of managing delivery teams within an offshore/onshore global delivery model.
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.
