Quality Manager Medical Coding

Job Summary

The Quality Manager – Medical Coding will oversee and lead the Quality Assurance (QA) team to ensure coding accuracy, regulatory compliance, and adherence to client SLAs across multiple RCM projects. This role requires strong leadership, deep domain expertise in Hospital Facility and Professional (Physician) Coding, and a strategic mindset to drive continuous improvement and team development.

Key Responsibilities

• Team Leadership & People Management

  • Lead and manage a team of 100+ Quality Analysts across diverse RCM coding projects.
  • Foster an inspiring and collaborative team environment with open communication.
  • Plan and allocate QA capacity based on workload and project needs.
  • Delegate responsibilities, establish clear timelines, and monitor performance.
  • Coach, train, mentor, and guide QAs to enhance competency and productivity.
  • Address team concerns, resolve conflicts, and ensure a healthy work environment.
  • Recognize and reward high-performing team members.

• Quality Assurance & Compliance

  • Ensure high-quality coding delivery aligned with client SLAs and industry guidelines.
  • Implement and enhance the Quality Management System (QMS).
  • Conduct regular quality reviews, including random audits of auditors.
  • Perform root cause analysis (RCA) on audit findings and implement corrective actions.
  • Identify knowledge gaps and drive structured action plans with Quality Leads & Operations.
  • Monitor and publish performance metrics, KPIs, and quality trends.

• Process Excellence & Continuous Improvement

  • Identify opportunities for process improvement and workflow optimization.
  • Encourage innovation, automation, and best practices within the QA team.
  • Collaborate with cross-functional leaders to strengthen quality delivery and compliance.

Competency & Knowledge Requirements

• Strong expertise in RCM coding for Hospital Facility and Physician (Professional) Coding.
• In-depth knowledge of E&M, ED, Surgery, IVR, and UHDDS guidelines.
• Comprehensive understanding of Anatomy, Physiology, Pathophysiology, Pharmacology, and clinical documentation.
• Ability to interpret Operative Reports, ED charts, Surgery records, and complex documentation.
• Strong understanding of compliance risks: upcoding, downcoding, fraud/abuse, documentation inflation, HIPAA, CLIA.
• Excellent communication skills, analytical ability, and team-handling skills.
• Proficient in coding guidelines and audit methodologies.
• PREFERRED: Certified Professional Coder (e.g., CPC, CCS, CIC, COC, CCS-P).

Additional Details

• Notice Period: Immediate or Short Notice Preferred
• Salary: As per industry standards
• Skills: ED, E&M, Surgery, ASC

Culture & Values

At Calpion, we're not just a company—we're a dynamic culture fueled by six core values: Agile, Collaborative, Innovative, Fun, Inclusive, and Passionate. These values drive our every move:

• Agile: We thrive on change, adapting swiftly to new challenges.
• Collaborative: Together, we achieve greatness through teamwork and diverse perspectives.
• Innovative: We push boundaries, constantly exploring new ideas and solutions.
• Fun: Laughter and camaraderie make our workplace a joyous one.
• Inclusive: Diversity is our strength, ensuring every voice is heard and valued.
• Passionate: We approach every task with dedication and enthusiasm.