Program Management Lead, Offshore Coding Operations

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The Program Management Lead, Offshore Coding Operations conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Program Management Lead, Offshore Coding Operations works on problems of diverse scope and complexity ranging from moderate to substantial.

The Program Management Lead, Offshore Coding Operations optimizes the effectiveness of the offshore coding (post-visit) team. The lead analyzes the performance of the offshore coding team and creates strategies to maximize associate output. The Program Management Lead, Offshore Coding Operations works on problems of diverse scope and complexity ranging from moderate to substantial.

• Cultivate relationships with onshore and offshore coding teams including leaders.

• Serve as liaison and primary point of contact with the offshore (vendor) leaders.

• Strategy:
  Advises coding leaders to develop functional strategies (often segment specific) on matters of significance.

• In partnership with Coding Operational Excellence and Regional Coding Leaders, develop strategies for continuous improvement of offshore coding processes and quality.

• Post-Visit/Offshore Coding
  
  Collaboration:

• Partner with analytics to develop quality assurance program on post-visit reviews. (Frequency and sampling methodology to be determined).

• Analyze trends and share results with coding leaders/teams.

• Monitor quality and address performance gaps.

• Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.

• May participate in coder education programs on coding compliance.

• Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.

• Partner with coding teams (consultative coders) on the special handling of Mergers & Acquisitions:

• Other Duties:

• Lead Special Projects for onshore and offshore coding teams.

• Participate in chart reviews to identify educational opportunities.

• Conduct research as needed.

• Participate in Payer calls/chart reviews.

• May participate in provider education programs on coding compliance.

• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

• Bachelor’s degree in a relevant field (e.g., Health Information Management, Business Administration, Healthcare Administration)

• Active professional certification required: RHIA, RHIT, CCS, CRC, or CPC

• Minimum 5 years’ progressive experience in medical coding operations

• Minimum of 3 years’ direct experience managing or optimizing offshore coding teams and vendor partnerships

• Demonstrated success leading cross-functional initiatives and continuous improvement efforts in large, matrixed healthcare organizations

• Experience collaborating with analytics, training, and operational excellence teams to drive quality and efficiency in coding workflows

• Prior exposure to supporting mergers & acquisitions in a coding operations context preferred

• Master’s degree preferred.

• Advanced understanding of medical coding guidelines, healthcare regulations (including HIPAA, state and federal compliance), and payer requirements

• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and relevant coding/audit software

• Strong business acumen with proven strategic and critical thinking skills

• Ability to analyze complex quantitative and qualitative data, synthesize findings, and communicate actionable insights to leadership

• Outstanding verbal and written communication skills, with the ability to present to and influence diverse stakeholder groups

• Effective relationship-building skills with both onshore and offshore teams, including vendor management and leadership…