Manager - Operation

Job description

- Job Description: Strong expertise in multi-specialty surgical coding, auditing, and payment integrity processes. - In-depth knowledge of ICD-10-CM, CPT, HCPCS, modifier usage, and payer-specific coding guidelines. - Comprehensive understanding of CMS, Medicare, Medicaid, LCDs, NCDs, commercial payer policies, and reimbursement methodologies. - Proficiency in coding software, auditing tools, and Electronic Health Record (EHR) systems. - Strong analytical and problem-solving abilities with a focus on identifying coding discrepancies and implementing process improvements. - Excellent leadership, coaching, and team management skills. - Effective communication and stakeholder management skills with the ability to collaborate across departments. - High attention to detail and commitment to coding accuracy, compliance, and quality standards. - Ability to manage multiple priorities, work independently, and meet deadlines in a fast-paced environment. - Sound knowledge of healthcare regulations, including HIPAA, HITECH, and industry compliance requirements. - Responsibilities: Lead and manage a team of medical coding specialists, ensuring accurate and timely auditing of multi-specialty surgical claims. - Provide coaching, training, and mentorship to enhance team performance and foster a collaborative work environment. - Oversee coding workflows, assign priorities, and ensure productivity, quality, and turnaround time targets are consistently achieved. - Stay current with coding guideline updates, payer policies, regulatory changes, and industry best practices, and communicate relevant updates to the team. - Conduct regular coding audits and quality reviews to ensure compliance with coding standards, documentation requirements, and organizational policies. - Collaborate with cross-functional teams, including Analytics, Repricing, Quality, and Compliance, to optimize coding operations and resolve coding-related issues. - Monitor and analyze key performance indicators (KPIs), identify performance gaps, and implement continuous improvement initiatives. - Apply payment integrity principles to identify coding inaccuracies, documentation deficiencies, billing errors, and revenue optimization opportunities. - Serve as the subject matter expert (SME) for multi-specialty surgical coding and payment integrity, providing guidance to internal stakeholders and supporting accurate documentation and coding practices. - Ensure compliance with healthcare regulations, including HIPAA, HITECH, CMS, Medicare, and commercial payer requirements. **Qualifications: Experience :** - CPC+ 3 years' experience in multi-specialty surgery coding including IVR, General surgery, Infusion and Injection and Radiation oncology - Auditing and denial management experience (Optional) - Extensive experience in medical coding, with a focus on surgery coding and strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems. **Qualification** **:** - Bachelor’s degree in clinical or healthcare information management or a related field. Relevant certifications (e.g. CCS, CPC, CPMA) are mandatory. **Communication** **Skill** **:** - Strong written (documentation) and oral communication skills **Working Hours:** - 40 hours per week as Full-time employee - Shift time: 8:00 PM IST - 5:00 PM IST - Weekends Off **Telecommuter/Internet requirements, if applicable:** - High Speed internet connection at home, must be broadband - Must understand and adhere with telecommuter policy.