Job Description

POSITION OVERVIEW:

We are seeking an experienced and detail-oriented Quality Assurance / Coding Manager to oversee and manage our outsourced vendor responsible for medical coding (diagnosis and procedure coding). This on-site role is critical in ensuring the accuracy and compliance of coding operations while maintaining high standards of quality assurance. The ideal candidate will have a strong background in coding and coding management, a thorough understanding of Optum and 3M tools, and a proven track record of achieving and maintaining a 95% coding accuracy rate.

OVERVIEW OF DUTIES:

• Oversee and manage the performance of the outsourced coding vendor, ensuring compliance with organizational policies and regulatory requirements.
• Conduct quality assurance reviews of coded records to ensure accuracy, compliance, and adherence to established standards and guidelines.
• Utilize Optum and 3M tools effectively for auditing and validation purposes.
• Develop and implement quality improvement initiatives to enhance coding accuracy and efficiency.
• Provide training and feedback to coding staff and vendor teams as needed.
• Monitor coding accuracy, compliance metrics, and reporting to ensure alignment with organizational goals.
• Collaborate with other departments to ensure seamless integration of coding processes and data flow.
• Maintain updated knowledge of coding standards, regulations, and best practices (ICD-10, CPT, HCPCS, etc.).
• Address and resolve discrepancies in coding and documentation in collaboration with clinical staff and coders.
• Minimum of **6 years of experience as a medical coder** with hands-on expertise in diagnosis and procedure coding.
• At least **2 years of experience in a managerial or supervisory role** overseeing medical coding operations.
• Proven ability to maintain a **coding accuracy rate of 95% or higher**.
• Certification by **AHIMA (e.g., CCS, RHIT, RHIA)** or **AAPC (e.g., CPC, COC)** is required.
• In-depth familiarity with **Optum** and **3M** coding tools.
• Strong knowledge of ICD-10, CPT, HCPCS coding, and medical terminology.
• Excellent communication, leadership, and organizational skills.
• Ability to work collaboratively in a fast-paced environment and manage multiple priorities.
• High level of attention to detail and commitment to quality.
• Experience working with outsourced coding vendors.
• Bachelor’s degree in Health Information Management or a related field.
• Familiarity with payer policies and reimbursement methodologies.

OVERIVEW OF QUALIFICATIONS:

• Minimum of **4 years of experience as a medical coder** with hands-on expertise in diagnosis and procedure coding.
• At least **2 years of experience in a managerial or supervisory role** overseeing medical coding operations.
• Proven ability to maintain a **coding accuracy rate of 95% or higher**.
• Certification by **AHIMA (e.g., CCS, RHIT, RHIA)** or **AAPC (e.g., CPC, COC)** is required.
• In-depth familiarity with **Optum** and **3M** coding tools.
• Strong knowledge of ICD-10, CPT, HCPCS coding, and medical terminology.
• Excellent communication, leadership, and organizational skills.
• Ability to work collaboratively in a fast-paced environment and manage multiple priorities.
• High level of attention to detail and commitment to quality.
• Experience working with outsourced coding vendors.
• Bachelor’s degree in Health Information Management or a related field.
• Familiarity with payer policies and reimbursement methodologies.

Preferred Qualifications:

• Experience working with outsourced coding vendors.
• Bachelor’s degree in Health Information Management or a related field.
• Familiarity with payer policies and reimbursement methodologies.

West Suburban Medical Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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