HCC coding - Team Lead QA

ECLAT Health Solutions; NTR; On-site; INR 800,000 - 1,200,000; Full time

Job summary

Eclat-Health-Solutions-4 is seeking a Quality Team Lead in India, Andhra Pradesh. Responsibilities include managing a team of Quality Analysts, overseeing daily productivity metrics, and ensuring compliance with HCC coding standards.

The ideal candidate will possess a minimum of 5 years of HCC coding experience and a background in Life Sciences. Strong team leadership skills and knowledge of medical terminology are required. This role offers opportunities for professional growth in a collaborative environment.

Qualifications

• Minimum 5 years of HCC coding experience.
• 1 year experience as Team Lead in HCC coding.
• Strong knowledge of medical terminology and anatomy.

Responsibilities

• Lead and manage a Quality team of 20 to 30 Quality Analysts.
• Oversee auditors’ daily productivity and track audit timelines.
• Conduct detailed error trend analysis and publish reports.

Skills

HCC coding experience

Team Lead experience

Human Anatomy knowledge

Excels proficiency

Team handling skills

Education

Bachelor's or Master's in Life Sciences

Tools

QC Tools like Parato chart

Job description

Responsibilities

• Lead and manage a Quality team of 20 to 30 Quality Analysts, ensuring high performance and adherence to organizational standards.
• Oversee auditors’ daily Productivity and Quality Metrics; track audit timelines and ensure timely delivery of accurate audit results to clients.
• Conduct team huddles, governance meetings, and ensure effective communication within the team.
• Perform detailed Error trend analysis; publish recurring error patterns and highlight areas requiring improvement.
• Conduct and publish Audit the Auditor reports – Validate HCC code assignments based on medical record documentation, ICD‑10‑CM coding guidelines, CMS rules, AHA Coding Clinic updates, and payer‑specific requirements. Provide detailed feedback on findings and areas for improvement.
• Stay current with evolving HCC coding guidelines, CMS regulations, and Medicare Advantage/risk‑adjustment model updates. Facilitate Quality Calibration sessions with cross‑functional teams to standardize and resolve coding discrepancies.
• Manage the rebuttal review process – Evaluate coder rebuttals, finalize responses, and ensure accurate alignment with quality standards. Lead the rebuttals process for external quality audits and reporting.
• Function as a Subject Matter Expert (SME) for all coding‑related clarifications for Quality Analysts.
• Act as a communication bridge, ensuring timely and accurate knowledge transfer from client updates to the QA team.
• Review medical records to identify documentation gaps, inaccuracies, or missing information affecting HCC code assignment.
• Collaborate with Operations and Training to identify coding trends or recurrent issues affecting quality metrics or reimbursement.
• Provide constructive feedback, training, and ongoing Education to Quality Analysts on HCC coding guidelines, risk adjustment practices, and documentation standards.
• Support training initiatives for coding teams on HCC updates, key changes, and corrective measures.
• Ensure adherence to HIPAA regulations and maintain complete confidentiality of patient information during all audit activities.

Skill Set

• Minimum 5 years of HCC coding experience (Retrospective / Concurrent / Prospective audits, and HEDIS reviews)
• Minimum 1 Year experience as Team Lead - HCC coding
• Strong knowledge of Human Anatomy, Physiology and Medical Terminology.
• Strong knowledge on Excels, QC Tools like Parato chart.
• Strong Team handling skills

Qualifications

• Bachelor's or Master's in Life Sciences: BAMS, BHMS, BDS, BPT/MPT, B Pharm/M Pharm, B.Sc./M.Sc. (Nursing, Nutrition, Zoology, Biology, Biochemistry, Microbiology, Biotechnology, Genetics, Physician Assistant, etc.)