Coding Quality Assurance (QA) Manager
New
A
AledadeHealth care
Candidates should be comfortable working remotely from anywhere within the US, across all US time zones., all US time zonesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- Minimum of 4 years of HCC coding experience with 2 years specifically focused on coding quality assurance, auditing, or compliance monitoring.
- Required Skills
- ComplianceQuality AssuranceEHR
Requirements
- Bachelor’s Degree in health care management, nursing or related field, or an Associate Degree with relevant CDI/coding management experience.
- Minimum 4 years of HCC coding experience.
- Minimum 2 years of experience specifically in coding quality assurance, auditing, or compliance monitoring.
- Active professional credentials from AAPC and/or AHIMA (e.g., CRC, CCS, CPC, or CPMA).
- Deep mastery of ICD-10-CM coding guidelines.
- Expertise in CMS Risk Adjustment guidelines and RADV audit rules.
- Strong knowledge of clinical documentation requirements.
- Proficiency with EHR systems and encoder software.
Responsibilities
- Lead, mentor, and manage a team of QA Specialists, establishing goals and monitoring productivity.
- Perform comprehensive quality assurance reviews for coding completed by internal and external partners.
- Design and maintain standard operating procedures, audit workflows, and coding quality guidelines.
- Act as a subject matter expert during external payer audits including RADV, Medicare, and Commercial audits.
- Evaluate third-party vendor accuracy and manage corrective action plans.
- Translate audit findings into educational feedback loops for internal CDI specialists and vendors.
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