Manager - Quality Profee Multispecialty E/m

Guidehouse India Pvt Ltd; Chennai; On-site; INR 1,800,000 - 2,400,000; Full time

Benefits offered by this job

Comprehensive benefits package

Learning & development programs

Job summary

Guidehouse India Pvt Ltd in Chennai seeks a Lead QA Specialist in Coding Quality to plan, monitor, and evaluate daily QA production, ensuring client deadlines are met. You will work with the Director of Coding Operations to adjust schedules during issues and mentor coders.

Responsibilities include reviewing documentation for ICD-9-CM and CPT-4 coding accuracy, abstracting data for reimbursement, and maintaining QA reports in Guide Audit for client reporting.

Qualifications

• Accredited medical coders (CCA, CCS, CPC, CPC-H) with at least 7+ years’ experience.
• 10+ years’ experience in medical coding.
• Strong analytical, research, and organizational skills.

Responsibilities

• Plan, monitor, direct and evaluate QA production daily.
• Review medical record documentation for accuracy in code assignment (ICD-9-CM and CPT-4).
• Abstract and compile data from medical records for optimal reimbursement.
• Answer queries from QA staff and escalate as needed.
• Coordinate QA meetings with QA and production staff and mentor coders.
• Ensure adherence to coding guidelines and standards.

Skills

Medical Coding

Analytical skills

Organizational skills

Mentoring/Training

Education

CCA, CCS, CPC, CPC-H

Tools

Microsoft Office

Job description

Job Family:Coding Quality OP (India)Travel Required:Up to 25%Clearance Required:NoneWhat You Will Do:Plans, monitors, direct and evaluate QA production on a daily basis. Ensures that daily schedules are met and communicates with Director, and Coding Operations if situations occur that hinder meeting deadlines. If system issues or other emergencies delay QA, an implement measures/schedules to return to established schedules at the earliest possible time. This should be done closely with each quality specialist to ensure the needs are met and that satisfy our client requirements.Responsible for ensuring that the QA communicates a valid, workable schedule for his or her client each week. Accurate, sensible & on-time.**If this doesn’t happen properly, it’s the responsibility of the Lead QA Specialist to make it happen promptly.Review medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 coding conventions. Sequence the diagnosis and procedures using coding guidelines. When applicable, ensure MS-DRG/APC assignment is accurate. Abstract and compile data from medical records for appropriate optimal/complaint reimbursement for hospital and/or professional charges. This involves reviewing code assignments that are not straightforward or the documentation in the record is inadequate, ambiguous, or unclear for coding purposes.Answers queries from the quality staff on a day to day basis and escalating to the Director of Coding as necessary.Meets agreed sampling targets and accuracy.Keeps abreast of coding guidelines and reimbursement reporting requirements.Documents QA data on teams of QA/coders and records findings in the QA system (Guide Audit), which will be for reporting to the client, identifying risk areas, development of training and education programs and development/implementation of standardization within the organization. This also involves guidance and mentorship of coders.Helps to ensure that continuing education is planned, scheduled and completed for all coding/QA teams through the coordination of the US.Coordinates scheduled quality meetings with the QA and production staff.Brings identified concerns to Guidehouse’s coding compliance management for discussion.Project Launch - Active involvement in project launch sessions along with team leaders to understand the coding process.Have a rotational arrangement and is flexible to work with any given team as assigned.Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. -Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques to effectively apply ICD-9-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.Assist with research and development and presentation of continuing education programs on areas of specialization.Assist with special projects as required. Example: Focused audits; client launches, etc.Shall understand and abide by the organizations’ information security policy and protect the confidentiality, integrity and availability of all information assets.Shall report incidents related to security of information to concerned authorities.What You Will Need:Key Skills: Medical CodingExp. Level: 10+yearsQualifications: Accredited medical coders (CCA, CCS, CPC, CPC-H) with at least 7+ years’ experience.Ensure data collection capability in relevant systems and business processesStrong analytical, research, and organizational skills required.ICD-10-PCS coding systems, ensuring accuracy and compliance with all regulatory and reimbursement requirementsWhat Would Be Nice To Have:Superior problem-solving abilitiesExperience mentoring and training Team Leader and Associates.A flexible mindset to learn.Excellent detail-oriented skills and a highly reliable work ethic.Proficiency in Microsoft Office (Word, Outlook, Excel).Ready to invest in Automation opportunities for process/business improvement.About Guidehouse IndiaAt Guidehouse India, we’re redefining what’s possible by creating opportunities that change lives. Guidehouse is a global professional services firm that delivers advisory, technology, and managed services to clients across both the commercial and public sectors. Our teams turn bold ideas into solutions that transform industries, strengthen communities, and drive meaningful impact worldwide.Across our Chennai, Trivandrum, and Gurugram locations, you’ll find opportunities where your passion and curiosity help shape what comes next. With cutting edge benefits, innovative learning and development programs, and a people first culture, we empower our people to lead with purpose.We continue to expand our teams and capabilities across India, investing in state-of-the-art offices and high impact work. Here, you’ll collaborate with experts from around the world, build deep expertise, explore new domains, and accelerate your professional growth while making a real impact.What We OfferAt Guidehouse India, we are committed to supporting the well-being of our people and their families at every stage of life. We offer competitive compensation and a comprehensive benefits package designed to help you thrive both inside and outside the workplace.Our benefits include resources such as in house physician consultations, nutritious food options at the workplace, and confidential counseling through our Employee Assistance Program, along with other wellness focused offerings that support your overall well being.Our comprehensive learning and development programs ensure you’re continuously upskilled and ready to tackle what’s next, so you can shape your own career path while contributing to meaningful, purpose driven work.Important Fraud NoticeAll official recruitment communications from Guidehouse will come from email addresses ending in @guidehouse.com or @myworkday.com. Guidehouse never charges fees, requests money transfers, or collects payments from educational institutions for recruitment events. Please do not share banking or personal financial information with anyone claiming to represent Guidehouse for hiring purposes.Contact UsIf you have visited our website to explore career opportunities or to apply for a position and have questions, please contact the Guidehouse Recruiting team at [e-mail]. All information you provide will be kept confidential and used only as required to support the recruitment process.To learn more about Guidehouse in India, visit www.guidehouse.com/india.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.