Quality Assurance Specialist

Quality Assurance Specialist - MCC

Experience - 5 - 7 years

Regular Shift Timings / Full Time Role - Permanent

Location: Mumbai

Roles and Responsibilities:

• Possess Knowledge on Risk adjustment models - Medicare, Commercial and Medical aid.
• Should be well versed in coding standards and guidelines including ICD - 10 - CM guidelines, AHA coding clinic updates and client specific guideline requirements.
• Should be able to perform QA audits for multiple projects.
• Derive effective QA sampling and audit methodology for the projects assigned.
• Possess analytical skills to monitor and measure the quality trend in the coding projects.
• Perform root cause analysis, identify knowledge gaps, and conduct training to project team.
• Review scope document and guidelines for new clients before the start of the project and own pilot project delivery to meet client SLA on quality.
• Review and customize standard coding guidelines as needed.
• Identity error trends on client feedback and improve client experience by continuous improvements.
• Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors.
• Ability to respond to the internal coding queries with proper rationale.
• Follow external and internal compliance standards.

Required Skills:

• Medical coding experience minimum of 5 years is mandatory
• Worked at least 1 year as an SME/ QA.
• Experience in any coding specialty is preferred to handle the pilot projects.
• Risk adjustment coding experience is an added advantage.
• AAPC/ AHIMA Certification is mandatory
• Strong Knowledge in Anatomy and Physiology.