Key Responsibilities:

- - Lead and manage a Quality team of 20 to 30 Quality Analysts, ensuring high performance and adherence to organizational standards.
- Oversee auditors’ daily Productivity and Quality Metrics; track audit timelines and ensure timely delivery of accurate audit results to clients.
- Conduct team huddles, governance meetings, and ensure effective communication within the team.
- Perform detailed Error trend analysis; publish recurring error patterns and highlight areas requiring improvement.
- Conduct and publish Audit the Auditor reports - Validate HCC code assignments based on medical record documentation, ICD‑10‑CM coding guidelines, CMS rules, AHA Coding Clinic updates, and payer-specific requirements. Provide detailed feedback on findings and areas for improvement.

- • Stay current with evolving HCC coding guidelines, CMS regulations, and Medicare Advantage/risk‑adjustment model updates. • Facilitate Quality Calibration sessions with cross‑functional teams to standardize and resolve coding discrepancies.
- • Manage the rebuttal review process - Evaluate coder rebuttals, finalize responses, and ensure accurate alignment with quality standards. • Lead the rebuttals process for external quality audits and reporting.
- - Function as a Subject Matter Expert (SME) for all coding‑related clarifications for Quality Analysts.
- Act as a communication bridge,



ensuring timely and accurate knowledge transfer from client updates to the QA team.
- Review medical records to identify documentation gaps, inaccuracies, or missing information affecting HCC code assignment.
- Collaborate with Operations and Training to identify coding trends or recurrent issues affecting quality metrics or reimbursement.
- Provide constructive feedback, training, and ongoing Education to Quality Analysts on HCC coding guidelines, risk adjustment practices, and documentation standards.
- Support training initiatives for coding teams on HCC updates, key changes, and corrective measures.
- Ensure adherence to HIPAA regulations and maintain complete confidentiality of patient information during all audit activities.

Skill Set:

- Minimum 5 years of HCC coding experience (Retrospective / Concurrent / Prospective audits, and HEDIS reviews)
- Minimum 1 Year experience as Team Lead - HCC coding
- Strong knowledge of Human Anatomy, Physiology and Medical Terminology.
- Solid knowledge on Excels, QC Tools like Parato chart.
- Strong Team handling skills
- AAPC or AHIMA certification (e.g., CCS / CRC / CPC) – Mandatory.

Qualifications:

- Bachelor's or Master's in Life Sciences: BAMS, BHMS, BDS, BPT/MPT, B Pharm/M Pharm, B.Sc./M.Sc. (Nursing, Nutrition, Zoology, Biology, Biochemistry, Microbiology, Biotechnology, Genetics, Physician Assistant, etc.)

📌 HCC - Team Lead QA (India)
🏢 Eclat Health Solutions
📍 India