Prateek Jain
Manager |Lean Six Sigma Certified|Service Delivery Expert|Continuous Improvement Specialist|Strategic Planning and Execution
- Role
- Quality Manager at Advantmed India LLP
- Location
- Indore, MP, IN
- LinkedIn followers
- 500 followers
About Prateek Jain
KPO/BPO Professional with more than 11 years of experience in US healthcare/RCM/Medical…
Experience
Quality Manager
Jun 2024 — Present · Ahmedabad, IN
Audit and Accuracy Management • Ensure coding accuracy targets (e.g, 95% or higher) are consistently met. • Review and validate coding errors identified by auditors and ensure appropriate corrective actions. • Conduct root cause analysis (RCA) for errors and implement measures to reduce recurrence. • Ensure compliance with industry standards, guidelines (ICD-10, CMS), and client-specific requirements. Quality Review and Feedback • Conduct periodic quality checks on coders’ performance and provide constructive feedback. • Facilitate individual and team feedback sessions to address recurring issues and best practices. • Monitor error trends and communicate them to senior management and operations teams. Process Improvement and Error Reduction • Identify process gaps and suggest improvements in sampling, audit methodology, and training programs. • Collaborate with the operations team to develop strategies for reducing tamper errors and other coder performance issues. • Lead initiatives for continuous quality improvement (CQI) to streamline audit workflows. Team Development and Training • Identify training needs and facilitate upskilling programs for medical coders. • Conduct focused training sessions on new guidelines, protocols, or client updates. • Support onboarding and mentorship for new coding hires. Data Analysis and Reporting • Generate and analyze reports on coder accuracy, audit outcomes, and quality metrics. • Provide actionable insights from quality data to senior management for strategic decisions. • Use quality data to forecast and mitigate potential risk areas. Compliance and Risk Management • Ensure adherence to company policies, confidentiality, and data protection standards (e.g, HIPAA compliance). • Oversee external audit preparations and respond to client audit inquiries. • Proactively address non-compliance issues and coordinate with compliance team
Education
COP IPS ACADEMY INDORE
Bachelor of Pharmacy - BPharm
2009 — 2013
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