Quality Lead

Responsible for managing the Inpatient Precertification cases while ensuring that departmental goals, timelines of activities, and compliance measures are met.

• Work on a flexible shift basis on a 24/7 basis as per the schedule provided by the Team Leader.
• Adjudicate cases at the IP precertification level and authorize decisions within the stipulated turnaround time, maintaining the highest quality standards in line with policy terms and conditions.
• Perform complete file reviews, including multidisciplinary notes, TPR charts, physician orders, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, and progress notes.
• Request any medical documentation or find missing documents essential for decision making.
• Review DRG Severity of Illness (SOI) and revise CPT/ICD codes, discussing up‑coding issues with treating doctors and medical...