Designation: Associate Director – Quality [Medical Coding]

Department: Medical Record Review [Medical Coding] – Quality Assurance

Reporting: Director

Location: Pune

Requirements:

Experience: 12+ years in medical coding, with 5+ years in a quality leadership role.

Certifications: CPC, CCS, CRC, or equivalent (mandatory); CPMA preferred.

Education: Graduate in Life Sciences, Nursing, or Allied Health.

Tools: Proficiency in coding platforms (e.g., 3M, Optum Encoder), audit tools, and BI dashboards.

Job Summary:

The Associate Director is responsible for leading the quality assurance function within the medical coding division. This role ensures coding accuracy, regulatory compliance, and continuous improvement across all coding projects, particularly those involving HCC, inpatient, outpatient, and specialty coding for US healthcare clients.

Key Responsibilities:

Quality Assurance Leadership

- Build and manage a robust quality assurance framework for medical coding operations.
- Oversee internal and external audits, root cause analysis, and corrective action plans.
- Ensure adherence to ICD-10-CM, HCC Coding Guideline, Coding clinic and client-specific guidelines.
- Maintain coding accuracy benchmarks (typically 95%+).

Team Management

- Lead a team of QA auditors, trainers, and quality analysts.
- Conduct calibration sessions with coding teams and clients.
- Mentor and develop quality leads and senior auditors.

Client Engagement & Governance

- Act as the quality SPOC for client interactions, reviews, and escalations.
- Participate in client calibrations,



performance reviews, and compliance discussions.
- Provide insights and recommendations to improve coding quality and reduce denials.

Process Improvement & Compliance

- Drive continuous improvement initiatives using Six Sigma/Lean methodologies.
- Ensure compliance with HIPAA, CMS, and payer-specific coding requirements.
- Collaborate with training teams to address knowledge gaps and upskill coders.

Reporting & Analytics

- Monitor and report on quality KPIs, trends, and audit outcomes.
- Use data analytics to identify systemic issues and improvement opportunities.
- Present dashboards and insights to senior leadership and clients.

About Advantmed Founded in 2005, headquarters based in California, Advantmed is a leading Healthcare Information Management company that helps Health Plans & MCOs (Managed Care Organizations) optimize Revenue & improve Quality Outcomes. Advantmed partners with Health Plans & MCO to deliver optimal combination of capabilities unique to each organization needed to achieve the objectives including Risk Analytics, Quality Analytics software certified by NCQA for HEDIS Measures, risk adjustment coding, medical record retrieval, abstraction & coding services, including Provider Education.

How to Apply?

If you would like to pursue this position, please mail your updated resume at [email protected] , along with the following details

- Total & Medical Coding Experience: -
- Current Designation: -
- Current CTC: -
- Expected CTC: -
- Relocation to Pune: - Yes/No

📌 Associate Director - Medical Coding Quality (Pune)
🏢 Advantmed India
📍 Pune