Senior Medical Coding Quality Lead

Coding Quality Specialist

The Coding Quality Analyst role plays a vital part in the development of improved capabilities in documentation, coding, and compliance. This position assesses and reviews the overall quality of coding on accounts completed by Medical Coders, ensuring adherence to workflows and ethical coding.

This requires advanced knowledge of professional coding (CPT, ICD-10-CM, and HCPCS).

Duties and Responsibilities:

• Lead team direction, resolve problems, and provide guidance to team members.
• Administer the Quality Assessment process to ensure all quality standards/targets are met.
• Daily management of operational processes to ensure quality, efficiency, and productivity standards/targets are met.
• Serve as client contact for day-to-day operational issues and staff assignments, escalating any client concerns to management.
• Review and analyze reports, records, and data to meet and exceed client and company objectives.
• Collaborate with workgroups to resolve issues impacting internal and external customers.
• Reward and discipline employees; address complaints and resolve problems.
• Look for development and continuous improvement opportunities for the entire team.
• Ensure employees follow their schedules properly.
• Strive for new ways to increase efficient, accurate work assignments.
• Handle complaints, questions, and queries as necessary.
• Document general reports on each team member's performance and targets, ensuring they exceed targets.
• Monitor systems for optimal performance.
• Disseminate changes in guidelines and rules, monitoring changes in laws, regulations, and policies affecting clinical documentation and reimbursement to assure compliance.
• Foster an environment of teamwork and service excellence within the department.
• Participate in performance improvement activities.
• Assist in establishing, implementing, and maintaining a formalized review process to ensure compliance with contractual agreements regarding accuracy rates.
• Assist in creating, monitoring, and standardizing company policies and procedures to monitor the success of the data quality management plan, review areas of risk, investigate identified issues, report data analyses, and take appropriate steps to correct violations.
• Makes recommendations to ensure the highest compliance rate with the Med-Metrix quality management plan.
• Participate in conference calls/meetings with management and staff to address performance and training recommendations and implement improvement suggestions.
• Assist in new hire training classes, transition periods, and refresher trainings as needed.
• Knowledge of, understanding of, and compliance with all Med-Metrix policies and procedures.
• Provide feedback to management concerning possible problems or areas of needed improvement.
• Protect and disclose patients' protected health information (PHI) according to Health Insurance Portability and Accountability Act (HIPAA) standards.

Qualifications:

• Graduate of a Medical or Allied Medical course or has equivalent work experience.
• Holds AAPC and/or AHIMA certification. CPMA is an advantage.
• Proficient with E/M and CPT Procedure coding.
• Minimum six months experience with exceptional performance in chosen area of quality management Medical Coding – demonstrated HIPAA knowledge required.
• Able to work in a team-fostered environment and adjust to changing job responsibilities, shifting schedules, new procedures, and unexpected workloads and stresses.
• Possesses strong verbal, written communication, interpersonal skills, and analytical skills.
• Willingness and flexibility to work extended hours.
• An assertive self-starter who can work independently, yet function in a team environment.
• Ability to plan well, prioritize work, and maintain calmness under pressure.
• Understanding and strict adherence to all HIPAA regulations.