Outpatient Quality Manager

🕒 il y a 5 jours

🇺🇸 États-Unis – Télétravail

💵 $100 000 - $120 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

👻 Score fantôme 3%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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10 000+ employés

🏥 Santé

🛡️ Assurance

📦 Logistique

💰 €2 000 000 Venture Round en 2015-01

Healthcare • Insurance • Logistics

Choisir un partenaire digital ne concerne pas seulement les capacités — c’est également une question de collaboration et de caractère.

Description

• Drive execution and ongoing improvement of outpatient coding quality review programs, including initial audits, appeals, targeted reviews, provider- or concept-specific reviews, and ATA audits • Manage day-to-day outpatient quality review operations, including workflow distribution, inventory, QA aging, productivity, timeliness, client SLAs, quality expectations, and internal standards • Provide direct supervision to outpatient quality analysts through coaching, feedback, performance management, one-on-ones, training, development planning, and upskilling • Analyze audit accuracy, productivity, QA inventory, defect trends, root causes, auditor performance, documentation patterns, and quality metrics to improve team performance and quality results • Perform ATA audits and ensure determinations, documentation support, rationales, and outcomes are accurate and consistent • Ensure RCA categories are marked appropriately and recurring trends receive follow-up, coaching, clarification, process correction, or escalation • Lead regular calibration with outpatient quality analysts • Partner with Operations, Training, Technology, clients, and global partners to resolve issues and support audit quality solutions • Support program implementations and operational initiatives by defining quality expectations, review criteria, sampling approaches, workflow needs, reporting requirements, and quality controls • Identify responsible AI-in-the-workflow opportunities while maintaining human review, compliance, and data security • Monitor CMS, payer, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifier, and ICD-10-CM guideline updates • Perform all responsibilities in accordance with Compliance, Information Security, and Regulatory policies

🎯 Exigences

• CCS, CPC, RHIT, RHIA, or other relevant coding credential required; CCS or CPC preferred • Minimum 5 years of outpatient facility coding, auditing, or quality review experience • Understanding of ICD-10-CM, CPT, HCPCS, modifiers, OPPS, APC reimbursement, and outpatient payment methodologies • Prior leadership, supervisory, quality management, or team lead experience required • Experience applying Medicare LCDs, NCDs, NCCI edits, payer policies, and medical necessity requirements • Experience with outpatient audit operations, quality assurance, root cause analysis, coaching, and performance improvement • Strong outpatient coding expertise across complex facility services • Proficiency in modifier application, CPT/HCPCS coding, ICD-10-CM coding, NCCI edits, MUEs, and Medicare/payer-specific guidelines • Ability to evaluate audit accuracy and validate findings, no-findings, rationales, documentation, and coding guidance • Ability to write professional quality notes citing Official Coding Guidelines, Coding Clinic, AMA CPT Assistant, CMS guidance, LCD/NCD policies, and other recognized sources • Leadership, coaching, mentoring, verbal communication, written communication, analytical, root cause analysis, decision-making, problem-solving, organizational, and attention-to-detail skills • Ability to manage competing priorities, inventory, and deadlines • Ability to work independently and collaboratively with Operations, Training, Technology, clients, and global partners • Flexibility, adaptability, accountability, and sound judgment in a fast-paced audit environment • Technical knowledge and ability to learn audit tools, reporting platforms, and workflow systems • Ability to leverage approved AI-enabled tools and workflow technology • Proficiency with Excel, PowerPoint, Outlook, Word, and audit productivity/reporting tools

🏖️ Avantages

• Exciting, fast-paced, and innovative environment • Opportunity to work closely with experienced, world-class Healthcare consultants • Opportunities to learn multiple aspects of clients’ businesses • Mentoring program with guidance/coaching from senior-level professionals • Opportunities for personal and professional growth • Opportunities for further growth and development within the company and beyond • Limited travel may be required for team meetings • Remote work from home