Primary Duties & Responsibilities
Operational Leadership & Quality Assurance Management
Direct and manage the internal department’s day-to-day coding and auditing processes.
Establish quality assurance workflows, establish guidelines, and delegate work across internal and global teams to optimize operational efficiency.
Oversee coding and billing compliance monitoring for gGastro/gMed and EMA/PM BOOST clients.
Subject Matter Expertise & Query Support
Serve as the primary coding SME for ModMed India COE coders and the broader BOOST team.
Resolve complex coding queries, documentation clarifications, and billing items to ensure accurate claim generation.
Vendor Oversight & Denial Mitigation
Partner with the Manager of Medical Coding and Auditing to conduct recurring quality calls with global coding vendors.
Analyze coding denial trends, drive root-cause analysis, lead knowledge transfer sessions, and conduct regular trainings for internal and vendor teams.
Process Innovation & Documentation
Proactively design, create, and maintain Standard Operating Procedures (SOPs), Quick Reference Guides (QRGs), and client-specific instruction sets for gMed and EMA/PM platforms.
Develop client-facing communications and workflow guides to elevate client understanding of coding best practices.
People Management, Compliance & Team Development
Partner with the People Team (Talent Acquisition and Business Partners) to recruit, interview, onboard, and train top talent.
Conduct regular 1:1 performance meetings (weekly/biweekly) and execute annual and mid-year performance reviews.
Mentor staff to maximize potential, efficiency, and professional growth.
Participate in BOOST committee calls to assess coding requirements and resolve compliance items.
Key Attributes & Organizational Scope