Medical Coding

3 weeks ago

Pasig, Philippines Risewave Consulting Inc. Full time

Key Responsibilities Supervise daily operations of the coding QA team, specifically SDS & Observation audits. Conduct internal audits to evaluate accuracy, consistency, and regulatory compliance in SDS coding, when needed. Monitor coding performance and quality metrics; provide actionable feedback to improve team effectiveness. Develop, implement, and maintain coding QA policies and procedures in collaboration with leadership. Collaborate with coding education staff to identify training needs and deliver targeted education based on audit findings. Act as a subject matter expert for SDS & Observation coding questions and escalated cases. Ensure coding practices align with federal guidelines, payer-specific policies, and organizational goals. Provide detailed reporting and analysis of audit results to leadership, identifying trends and risks. Maintain up-to-date knowledge of coding standards, CMS regulations, payer guidelines, and industry best practices. Participate in hiring, onboarding, and mentoring QA. Support coding projects, system upgrades, and other initiatives as assigned. Qualifications Associate or bachelor’s degree in health information management, Health Sciences, or related field preferred. Active certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent required. CPMA certification is preferred but not required. Experience Minimum 5 years of medical coding experience , with at least 2 years specializing in Same Day Surgery (SDS) & Observation. Minimum 2 years of supervisory or lead experience in a QA or auditing role. Strong experience with CMS, NCCI edits, and payer-specific coding guidelines. IVR experience is preferred but not required. #J-18808-Ljbffr

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