Quality Lead - Profee

Job Family:

Coding Quality OP (India)

Travel Required:

None

Clearance Required:

None

What 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.

• 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.

What You Will Need:

• Experience: 6+ years of coding experience with at least 2 years of experience as QA/SME.
• Ability to handle multiple clients with team of expertise to maintain quality and training
• Ability to communicate to onshore review team and clients, have excellent interpersonal, listening skills and organizational skills.
• Can work in toughest of conditions, able to handle diverse situations.
• Should be able to manage 10-15 QA’s.
• Able to work under pressure and deliver expected deliverables.
• Should possess people management skills and conflict management
• Should have excellent analytical skills and exposure to basic MS tools.
• Should have good knowledge on Multispecialty E/m & Denial. Exposure to surgery will be an additional advantage.

What Would Be Nice To Have:

• Proficiency in MS Office/excel

• Experience in coding software or encoder (3M, Trucode, Optum)

• Familiarity with EMR systems (EPIC, Cerner, etc.,)

• Knowledge of multiple coding specialties (ED, EM (OP&IP), etc.

About Guidehouse India

At 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 Offer

At 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 Notice

All 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 Us

If 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 [email protected]. 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.