Director - Quality; Medical Coding

Position: Director - Quality (Medical Coding)
Location: Athiyur

Position:
Director -  Coding
Reporting To:  Vice President - Medical Coding (Quality )

Department:  Medical Coding – Quality & Compliance

Profile Description
This role is responsible for defining and driving the quality strategy across one or more medical coding portfolios while ensuring coding accuracy, regulatory compliance, client satisfaction, and continuous process improvement. The Director – Quality will lead enterprise quality initiatives, strengthen audit governance, partner with Operations and Training teams, and leverage analytics to improve coding quality, reduce denials, and enhance client outcomes.

The role is also responsible for ensuring compliance with industry standards, payer guidelines, and organizational quality frameworks.

Key Responsibilities
Process
Own the Quality Management System (QMS) across assigned coding portfolios and ensure consistent execution of quality processes.
Establish and maintain coding quality standards aligned with ICD-10-CM, CPT, HCPCS, payer policies, CMS guidelines, NCCI edits, and specialty-specific coding requirements.
Drive achievement of internal and client-defined quality SLAs across all accounts.
Develop audit methodologies including concurrent, retrospective, prospective, focused, and validation audits.
Ensure calibration across Quality, Operations, Training, and Client teams through standardized audit guidelines.
Lead root cause analysis (RCA) for quality defects and implement effective corrective and preventive actions (CAPA).
Monitor coding trends, denial trends, payer edits, and regulatory updates to proactively mitigate quality risks.
Drive continuous process improvement initiatives through Lean, Six Sigma, and automation opportunities.
Standardize quality scorecards, audit tools, and governance dashboards across portfolios.
Ensure readiness for client audits, internal audits, compliance reviews, and external accreditation requirements.
Establish governance around coding policy changes and ensure timely implementation across operations.
People
Build and lead a high-performing Quality organization across multiple coding specialties.
Coach and mentor Quality Managers and Leads to improve audit effectiveness and leadership capabilities.
Develop competency frameworks for auditors and quality professionals.
Partner with Operations and Learning teams to identify knowledge gaps and implement targeted training interventions.
Drive certification programs (AAPC/AHIMA), continuing education, and ongoing competency assessments.
Promote a culture of quality ownership across Operations rather than quality inspection.
Drive employee engagement, succession planning, talent retention, and career development within the Quality function.
Conduct regular calibration sessions to ensure inter-auditor reliability and consistency.
Foster innovation by encouraging adoption of AI-assisted quality monitoring and analytics.
Client
Serve as the Quality leader during client governance meetings including Weekly Business Reviews (WBRs), Monthly Business Reviews (MBRs), and Quarterly Business Reviews (QBRs).
Present quality performance, audit findings, denial trends, and improvement initiatives to clients.
Build trusted client relationships through proactive communication and consultative quality leadership.
Partner with client coding compliance teams to resolve coding interpretation differences.
Support client onboarding, transitions, and implementation activities by establishing quality governance.
Lead provider education initiatives arising from coding audit findings when required.
Ensure client quality KPIs, contractual obligations, and compliance expectations are consistently achieved.
Financial
Improve client ROI by reducing coding defects, rework, denials, and revenue leakage.
Partner…