CODING QUALITY MANAGER
ZETA TOWER
ZETA TOWER
ZETA TOWER
ZETA TOWER
ZETA TOWER
ZETA TOWER
Make your next big career move by applying as KMC Solutions' next CODING QUALITY MANAGER
The Coding Quality Manager is responsible for developing and implementing coding audit monitoring and education activities for providers and coders, in support of the organization’s adherence to applicable CMS requirements, official coding guidelines, government regulations and internal policies. Manages and directs a team of Coding Audit Educators. Serves in an advisory capacity to leadership and physicians as it relates to documentation, coding, and regulatory compliance.
On top of your salary, here are the exciting benefits you can look forward to:
- Annual incentive plan, HMO entitlement with 2 dependents upon hire, 20 days leave credit with 5 days monetization for unused credit
- Health Insurance/HMO
- Enjoy unlimited MadMax Coffee
- Diverse learning & growth opportunities
- Accessible Cloud HR platform (Sprout)
- Above standard leaves
The main responsibilities of a CODING QUALITY MANAGER include:
- Develops and oversees ongoing coding quality audit program for provider services encounters.
- Identifies high risk areas, plans, and executes audit monitoring activities to evaluate compliance with laws, regulations, policy and procedures, coding and billing standards, etc.
- Creates and implements standardized audit monitoring methodology and oversees team’s adherence to goals and scheduled audits.
- Develops presentations and delivers education sessions to providers, coders, and other members of revenue cycle teams. Conducts one-on-one and group sessions with providers and other members of the organization via teleconferencing platforms. Coaches team members to perform provider education sessions.
- Responsible for leadership, direction, and work product of Coding Auditor and Educator team.
- Ensures that the coding quality team stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10 and CPT updates) for Physician Services coding. Reviews AHA and CPT quarterly coding update publications.
- Assists other departments within the organization with coding questions, reviews, or inquiries.
- Reviews and prepares response to external payer and compliance audits, including but not limited to RAC, payer audits, and external compliance audits.
- Understands, interprets, and applies coding guidelines for coding.
- Stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM/PCS and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10 and CPT updates) for Physician Services coding. Reviews AHA and CPT quarterly coding update publications.
To apply, you must be an expert on the following requirements:
- 3- 4+ years orthopedic surgery and/or Evaluation and Management (E/M) coding audit experience required. Other surgical specialties considered.
- 2+ years supervisory or manager experience required.
- Must have current CPC, CPMA, COSC or CEMC certification from AAPC. Will consider CCS-P or CCS certification from AHIMA, with relevant work experience.
- Associate degree in health information management, health services administration, or related field desired.
- Proficiency in MS Office products - intermediate to advanced knowledge of MS Excel.
- Must successfully pass pre-hire coding assessment.
- Strong technical knowledge of Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding, and official coding guidelines.
- Knowledge of disease pathophysiology and drug utilization.
- Knowledge of NCCI edits structures.
- Must be detail oriented and have the ability to work independently.
- Computer knowledge of MS Office, including Word and Excel.
- Must display excellent interpersonal skills.
- Ability to demonstrate initiative and discipline in time management and assignment completion.
- Ability to work in a virtual setting under minimal supervision.
It will also be favorable if you are knowledgeable in:
Additional relevant knowledge or experience related to the above requirements will be considered an advantage.
The successful candidate must submit the following pre-employment requirements
- Scanned copy of valid NBI Clearance
- Accomplished Medical or PEME Slip (covered by KMC)
- 2x2 & Half body picture with white background
- Proof of government numbers (TIN, SSS, Pag-ibig, & Philhealth)
- Photocopy of 2 valid IDs – front & back (government-issued)
- Clear copy of your Birth Certificate (PSA or NSO)
- Accomplished HR Forms & Promissory Note (will be provided by KMC’s Onboarding Team
Click here to view the complete list of KMC’s pre-employment requirements.
KMC Careers
If you're a rockstar at what you do and looking to be a part of our amazing story, we want to hear from you!
We offer attractive salaries and benefits plus you get to work in some of the Philippines' best flexible workspaces. Our employees also get to enjoy exclusive discounts, rewards and freebies, and invites to our monthly events. We are always recruiting for roles in IT & Development, Marketing, Business Administration, HR & Recruitment and Legal & Finance Roles.
KMC provides quality employment opportunities for job-seekers looking for a career that is both challenging and fulfilling. We are also committed to providing equal opportunities at every selection stage. We do not discriminate due to age, gender, sexual orientation, ethnicity, nationality, and religion.
Work with Us. Grow with Us.
KMC Solutions offers a variety of career opportunities in Metro Manila, Cebu and Clark & Iloilo. We are always looking for talented and enthusiastic individuals who are ready to make their next big career move.
Our Culture
At KMC, we foster an inclusive and positive workplace for all. We push our members to succeed in everything they do through our collaborative work environment. We encourage our community to work hard and reach their full potential while delivering results that matter for our members and you as professionals.
We host amazing and quality events and implement people-centric policies to work flexibly. We ensure that everyone in our expansive network is engaged, from our internal employees and those who work on behalf our offshore partners.
Life within KMC: Work Hard Party Harder
At KMC, we work hard and we are committed to putting our best foot forward in everything we do. Everyone is encouraged to be an individual while also working for the collective good of the KMC Community. We believe mistakes are opportunities and that you should not present a solution without a problem.
We also know when hard work deserves to be recognized so we reward our employees with monthly parties, free trips and much much more!
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