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Program Management Lead – Offshore Coding Operations
Location
United States
Posted
128 days ago
Salary
$104K - $143K / year
Seniority
Senior
Job Description
Program Management Lead – Offshore Coding Operations
CenterWell Senior Primary Care
• 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 • optimizes the effectiveness of the offshore coding (post-visit) team • analyzes the performance of the offshore coding team and creates strategies to maximize associate output • cultivates relationships with onshore and offshore coding teams including leaders • serves as liaison and primary point of contact with the offshore (vendor) leaders • advises coding leaders to develop functional strategies (often segment specific) on matters of significance • develops strategies for continuous improvement of offshore coding processes and quality in partnership with Coding Operational Excellence and Regional Coding Leaders • partners with analytics to develop quality assurance program on post-visit reviews • analyzes trends and shares results with coding leaders/teams • monitors quality and addresses performance gaps • researches and interprets 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 • partners with coding teams (consultative coders) on the special handling of Mergers & Acquisitions • leads Special Projects for onshore and offshore coding teams • participates in chart reviews to identify educational opportunities • conducts research as needed • participates 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
Job Requirements
- Bachelor’s degree in a relevant field (e.g., Health Information Management, Business Administration, Healthcare Administration)
- Active professional certification required: 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
- 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 liaison
- Proven ability to work successfully in a fast-paced, dynamic, and matrixed environment
- Commitment to continuous improvement, operational excellence, and collaborative problem-solving
- Public speaking and group presentation experience required
- Demonstrated ability to educate and mentor staff on coding compliance and best practices
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- many other opportunities
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