06 Sep
|
IKS Health
|
Coimbatore
06 Sep
IKS Health
Coimbatore
Position: Director - Quality_Medical Coding
Reporting To: Vice President - Medical Coding (Quality )
Department: Medical Coding – Quality & Compliance
Profile Description
This role is responsible for defining and driving the quality strategy across one or more medical coding portfolios while ensuring coding accuracy, regulatory compliance, client satisfaction, and continuous process improvement. The Director – Quality will lead enterprise quality initiatives, strengthen audit governance, partner with Operations and Training teams, and leverage analytics to improve coding quality, reduce denials, and enhance client outcomes. The role is also responsible for ensuring compliance with industry standards, payer guidelines, and organizational quality frameworks.
Key Responsibilities
Process
Own the Quality Management System (QMS) across assigned coding portfolios and ensure consistent execution of quality processes.
Establish and maintain coding quality standards aligned with ICD-10-CM, CPT, HCPCS, payer policies, CMS guidelines, NCCI edits, and specialty-specific coding requirements.
Drive achievement of internal and client-defined quality SLAs across all accounts.
Develop audit methodologies including concurrent, retrospective, prospective, focused, and validation audits.
Ensure calibration across Quality, Operations, Training, and Client teams through standardized audit guidelines.
Lead root cause analysis (RCA) for quality defects and implement effective corrective and preventive actions (CAPA).
Monitor coding trends, denial trends, payer edits, and regulatory updates to proactively mitigate quality risks.
Drive continuous process improvement initiatives through Lean, Six Sigma, and automation opportunities.
Standardize quality scorecards, audit tools, and governance dashboards across portfolios.
Ensure readiness for client audits, internal audits, compliance reviews, and external accreditation requirements.
Establish governance around coding policy changes and ens
📌 Director - Quality (Medical Coding) (Coimbatore)
🏢 IKS Health
📍 Coimbatore