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    Quality Assurance Specialist - pune, India - Artifex HR Private Limited

    Artifex HR Private Limited
    Artifex HR Private Limited pune, India

    1 week ago

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    Description

    Quality Assurance Specialist - MCC

    Experience 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 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.
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