Clinical Operations QA Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct comprehensive overreads of chases for coders engaged in production.

• Facilitate the initial quality assurance process during the onboarding phase.

• Relay trends in coding errors to the Training and QA team.

• Aid in formulating action plans to address QA discrepancies.

• Support coders in resolving coding inquiries in accordance with Reveleer Coding Guidelines, AHA Coding Clinics, and CMS Coders Guidance on Medical Review.

• Develop and uphold quality control activities, which include bi-monthly performance evaluations and monthly quality assurance assessments.

• Monitor QA scores and ensure that necessary corrections are made in a timely manner.

• Identify outliers that necessitate retraining and establish action plans accordingly.

• Carry out one-on-one or group instruction in collaboration with the training team.

• Generate reports to examine error trends and share insights with the internal team.

• Work in partnership with QA teams to guarantee compliance with policies and procedures.

• Offer additional assistance as needed to fulfill customer obligations.

⛳️ Requirements

• Possession of a professional coding certificate from AHIMA/AAPC.

• At least 5 years of coding experience.

• In-depth knowledge of Medicare and Commercial Risk Adjustment, including Hierarchical Condition Category (HCC).

• Proficiency in computer skills.

• Access to high-speed internet from home.

• Strong commitment to maintaining the confidentiality of patient health information.

• Professional demeanor, articulate communication skills, and ability to work independently.

• Proficient in Microsoft Office applications, including Excel, Word, and PowerPoint.

• Familiarity with Adobe Pro.

• Capability to collaborate effectively with QA teams and staff across all levels.

🏝️ Benefits

• Medical, Dental, and Vision benefits.

• 401k with Employer Match.

• Generous PTO plan.

• Competitive salary.