Job Summary

The AVP – Medical Coding Quality will provide strategic and operational leadership to the organization's medical coding Quality function, ensuring consistent delivery of high-quality, compliant, and efficient coding services across multiple specialties and client engagements.

The role will be responsible for establishing robust quality governance frameworks, driving coding accuracy and audit effectiveness, optimizing quality assurance resources, and leading continuous improvement initiatives.

The incumbent will work closely with Operations, Training, Technology, and Client Services leadership to strengthen coding quality, improve operational efficiency, enhance client satisfaction, and support organizational growth.

The role will also drive quality transformation through AI-assisted auditing, automation, and data-driven performance management while developing a strong quality leadership pipeline.

The AVP will have direct accountability for the effectiveness of the Quality Assurance function and joint accountability with Coding Operations for overall coding quality performance and achievement of client quality SLAs.

Key Goals

·       Develop and execute a comprehensive medical coding quality strategy across offshore operations, ensuring consistent achievement of client quality standards and contractual SLAs.

·       Establish a robust, scalable, and standardized Quality Assurance Program across multiple specialties, business units, and client engagements.

·       Drive continuous improvement in coding accuracy, audit effectiveness, compliance, and operational efficiency through structured quality governance and risk management.

·       Partner with Coding Operations leadership to jointly own overall coding quality outcomes, with clearly defined responsibilities for audit effectiveness, coder performance, corrective actions, and SLA achievement.

·       Optimize QA capacity, audit coverage, resource utilization, and cost efficiency while maintaining service delivery commitments.

·       Strengthen collaboration with Operations and Training teams to identify recurring coding errors, implement corrective and preventive actions, and achieve sustainable quality improvements.

·       Lead quality-side adoption, validation, and governance of AI-assisted auditing and automation solutions in collaboration with Technology teams.

·       Enhance client satisfaction through proactive quality management, transparent reporting, timely resolution of escalations, and continuous improvement.

·       Build a high-performing quality leadership team through talent development, succession planning, and performance management.

·       Ensure effective management of the QA operating budget and drive measurable improvements in cost efficiency without compromising quality standards.

Job Profile

Quality Function

·       Provide strategic and operational leadership to a QA organization of 350+ auditors through a structured management hierarchy, ensuring capability, productivity, accountability, and scalable delivery.

·       Develop and implement organization-wide quality strategies, governance frameworks, policies, and standardized audit methodologies aligned with business objectives and client requirements.

·       Oversee quality management for OP (ED/SDS/ANC/OBV), ProFee Surgery & EM, HCC, Home Health and IP DRG projects.

·       Ensure consistent achievement of coding quality standards, client-specific requirements, and contractual SLAs across all assigned engagements.

·       Exercise direct ownership of audit quality, audit accuracy, audit coverage, and QA process effectiveness, while sharing accountability for overall coding quality outcomes with Coding Operations.

·       Own QA workforce planning, audit coverage strategy, resource utilization, productivity management, and cost optimization aligned with business growth and client requirements.

·       Drive effective implementation, monitoring, and adherence to the organization's Quality Management System (QMS).

·       Establish enterprise quality dashboards and governance mechanisms to monitor coding accuracy, audit effectiveness, defect trends, rework, and corrective action effectiveness.

·       Establish second-level audit, inter-auditor calibration, and audit dispute resolution frameworks to ensure consistency, reliability, and defensibility of audit findings.

·       Lead structured Root Cause Analysis (RCA) and Corrective and Preventive Action (CAPA) programs, with defined accountability, closure timelines, and verification of sustained improvements.

·       Identify systemic quality risks, coding error patterns, and process gaps, and implement proactive measures to prevent recurrence.

·       Ensure adherence to applicable ICD-10-CM/PCS, CPT, HCPCS, official coding guidelines, client-specific coding requirements, and relevant compliance standards.

·       Collaborate with Operations and Training leadership to identify competency gaps, develop targeted training interventions, and monitor improvements in coding performance.

·       Develop risk-based audit methodologies to prioritize high-risk specialties, complex accounts, new coders, and recurring error categories.

·       Lead quality readiness assessments for new client implementations, specialty expansions, process transitions, and operational scale-up.

·       Establish performance management frameworks for Quality Managers, Leads, and Auditors, promoting accountability, professional development, and leadership succession.

·       Drive QA productivity improvements and reduce the cost of poor quality through optimized audit processes, improved resource utilization, and reduction of avoidable rework.

·       Foster a high-performance quality culture through leadership development, employee engagement, knowledge sharing, and cross-functional collaboration.

AI, Automation & Quality Transformation

• Lead the identification and prioritization of opportunities for AI-assisted auditing, quality automation, predictive analytics, and workflow optimization.
• Define functional requirements, audit validation criteria, and quality acceptance standards for AI-enabled auditing solutions in collaboration with Technology and Operations.
• Own the quality-side evaluation and validation of AI-generated audit findings, including accuracy, consistency, reliability, and identification of false-positive and false-negative results.
• Establish appropriate human review, exception management, and quality governance controls for automated auditing processes.
• Partner with Technology teams responsible for solution development, technical implementation, system integration, and ongoing technical support.
• Drive adoption of approved automation solutions across QA teams through training, process alignment, change management, and performance monitoring.
• Measure the effectiveness of AI-assisted auditing through improvements in audit coverage, auditor productivity, turnaround time, and cost efficiency without compromising accuracy or compliance.
• Ensure appropriate safeguards for patient data confidentiality, information security, and applicable client and regulatory requirements.

Client Communication & Stakeholder Management

·       Lead client-facing quality governance, executive business reviews, escalation management, and continuous improvement initiatives.

·       Serve as a senior escalation point for critical coding quality concerns, audit disputes, and client-specific quality performance issues.

·       Partner with Operations, Training, Technology, and Client Services leadership to align quality initiatives with client expectations and organizational objectives.

·       Establish transparent client quality reporting mechanisms, including quality scorecards, error trend analysis, RCA findings, and corrective action updates.

·       Drive timely closure of client escalations and monitor the effectiveness of corrective measures to prevent repeat occurrences.

·       Collaborate with business leadership to support client retention, account expansion, and new business opportunities through strong quality performance and operational credibility.

·       Maintain accurate, complete, and compliant documentation relating to medical coding, billing, quality assurance, and client audit requirements.

·       Identify opportunities to strengthen client satisfaction, improve delivery consistency, and enhance the organization's value proposition through quality-led initiatives.

Quality Performance & Business Excellence

·       Define and monitor key quality performance indicators covering coding accuracy, audit effectiveness, SLA compliance, quality trends, rework, and corrective action effectiveness.

·       Drive measurable improvements in quality outcomes while balancing audit coverage, operational efficiency, and cost effectiveness.

·       Partner with operational leadership to identify and minimize quality-related revenue leakage, avoidable rework, and compliance risks.

·       Lead business excellence initiatives focused on process standardization, workflow optimization, scalability, and quality transformation.

·       Provide periodic quality performance, risk, resource utilization, and improvement updates to senior leadership.

·       Establish a culture of continuous improvement through benchmarking, performance analytics, and adoption of industry best practices.

Financial & Resource Management

·       Own planning, monitoring, and optimization of the Medical Coding Quality function's operating budget within approved financial parameters.

·       Establish efficient resource deployment models to balance audit coverage, quality risk, workload complexity, and client contractual requirements.

·       Monitor QA productivity, auditor utilization, cost per audit, and other agreed efficiency measures.

·       Identify cost-saving opportunities through workflow standardization, automation, improved staffing models, and reduction of non-value-added activities.

·       Evaluate the business case and expected return on investment for quality improvement and automation initiatives.

·       Partner with Finance and Operations to monitor quality-related costs and implement sustainable efficiency improvements.

·       Maintain accountability for QA functional cost performance without assuming ownership of overall coding business profitability, which remains with the designated business leadership.

People Leadership & Talent Development

·       Lead and develop Quality Managers and other quality leadership personnel to ensure consistent operational execution and management effectiveness.

·       Build a performance-driven culture focused on accountability, collaboration, continuous learning, and professional excellence.

·       Strengthening employee engagement and retention through career development, recognition, and structured performance management.

·       Develop future-ready QA capabilities through upskilling in advanced coding specialties, audit methodologies, analytics, and AI-assisted quality processes.

Educational Qualifications and Professional Certifications

·       Bachelor's degree in Life Sciences, Health Information Management, Healthcare Administration, or a related discipline.

·       Strong understanding of US healthcare medical coding operations, quality assurance practices, and coding compliance requirements.

·       AAPC or AHIMA certifications are mandatory

·       Lean Six Sigma Black Belt or Master Black Belt certification – highly preferred, with demonstrated experience leading enterprise-level quality improvement, process optimization, operational efficiency, and business transformation initiatives.

Experience Requirements

• Preferably 15+ years of overall experience in US healthcare medical coding, including substantial exposure to medical coding quality management.
• Minimum 7+ years of progressive leadership experience in Coding Quality, Coding Operations, Audit Management, or related functions.
• Strong experience in handling multi-specialty coding like inpatient DRG/outpatient facility/Risk adjustment/professional fee coding services.
• Exposure to quality automation, AI-assisted auditing, analytics, and process transformation initiatives will be highly desirable.