Coding Quality Director

19 hours ago


Manila, National Capital Region, Philippines Tenet Global Business Center, Inc. Full time

The Director of GBC Coding Quality is responsible for managing coding quality auditing and review services for Conifer's Global Business Center, ensuring compliance with Conifer Quality & Performance standards and policies.

**Job Summary:**

The Director of GBC Coding Quality is responsible for managing coding quality auditing and review services for Conifer's Global Business Center, ensuring compliance with Conifer Quality & Performance standards and policies.

**Key Responsibilities:**

  • Oversight of GBC Coding Quality teams and client SLAs around quality monitoring and reporting, ensuring Conifer Compliance and Quality & Performance policies and procedures are maintained and effectively carried out.
  • Continual assessment and improvement of Auditor and Audit Team performance through daily interactions, analysis, education, and implementation of sustainable performance improvement initiatives.
  • Collaboration with CRI Operational leaders to ensure the coding quality of all coders meets or exceeds quality standards, preparing necessary periodic reporting for Conifer and GBC leadership, clients, and Conifer governing bodies.
  • Input and maintenance of a standardized data quality management plan to ensure consistency of quality data for the organization's internal data needs.
  • Serving as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes, demonstrating a thorough knowledge of coding guidelines, governmental regulations, and third-party billing requirements.

**Requirements:**

  • Strong leadership and communication skills, problem-solving abilities, and good knowledge of coding and reimbursement systems.
  • Ability to build and maintain team cohesion, performance, and talent retention, serving as a resource to Conifer and client contacts.
  • Advanced knowledge of ICD-10-CM/PCS, CPT, and HCPCS code sets, MS-DRG & APR-DRG classification, and reimbursement structures, APC, OCE, NCCI, MUE classification.
  • Advanced knowledge of disease pathophysiology, drug utilization, and therapies.
  • Knowledge of revenue cycle structures of hospitals, physician offices, medical clinics, and third-party payors.
  • Moderate to advanced skills in MS Excel and PowerPoint.
  • Ability to work under deadlines and juggle multiple projects, working independently and as part of a team.

**Education/Experience:**

  • Eight (8) years of relevant experience in coding or auditing in both facility-based and provider-based settings.
  • Five (5) years of recent management experience related to coding quality and auditing functions.
  • Documented coding and auditing experience, advanced knowledge of ICD-10-CM/PCS, CPT, HCPCS classification systems, and CDI functions.

**Certifications/Licenses/Registrations:**

  • Degree: Healthcare/Clinical degree, MD, RN, Allied Health.
  • Coder Certification such as CCS, CIC, CPC.
  • AHIMA ICD-10-CM/PCS Trainer preferred.


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