Position Summary: We are seeking a detail-oriented and experienced Medical Coding QA Supervisor with specialized expertise in Same Day Surgery (SDS) and Observation coding to lead our quality assurance team. The ideal candidate will oversee the auditing task of QAs, ensure compliance with regulations and organizational standards, and support continuous improvement in coding accuracy and productivity. This role requires advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems with a strong focus on SDS procedures.
Key Responsibilities: • Supervise daily operations of the coding QA team, specifically SDS & Observation audits. • Conduct internal audits to evaluate accuracy, consistency, and regulatory compliance in SDS coding, when needed. • Monitor coding performance and quality metrics; provide actionable feedback to improve team effectiveness. • Develop, implement, and maintain coding QA policies and procedures in collaboration with leadership. • Collaborate with coding education staff to identify training needs and deliver targeted education based on audit findings. • Act as a subject matter expert for SDS & Observation coding questions and escalated cases. • Ensure coding practices align with federal guidelines, payer-specific policies, and organizational goals. • Provide detailed reporting and analysis of audit results to leadership, identifying trends and risks. • Maintain up-to-date knowledge of coding standards, CMS regulations, payer guidelines, and industry best practices. • Participate in hiring, onboarding, and mentoring QA. • Support coding projects, system upgrades, and other initiatives as assigned.
Qualifications: Education & Certification: • Associate or bachelor’s degree in health information management, Health Sciences, or related field preferred. • Active certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent required. • CPMA certification is preferred but not required. Experience: • Minimum 5 years of medical coding experience, with at least 2 years specializing in Same Day Surgery (SDS) & Observation. • Minimum 2 years of supervisory or lead experience in a QA or auditing role. • Strong experience with CMS, NCCI edits, and payer-specific coding guidelines. • IVR experience is preferred but not required.
Skills & Competencies: • In-depth knowledge of ICD-10-CM, CPT, and HCPCS Level II coding systems. • Proficient with EHR and coding software (e.g., EPIC, 3M, Optum). • Exceptional analytical and problem-solving skills. • Excellent communication and leadership abilities. • Strong attention to detail and commitment to accuracy and compliance. • Ability to work independently and as part of a team in a fast-paced environment.
Preferred Qualifications: • Experience with remote team supervision. • Previous experience with SDS and Observation coding audits and QA in a multi-specialty or large health system.