Coding Quality Assurance, QA Manager

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

📋 Description

• Lead, mentor, and supervise a team of QA Specialists.

• Set team objectives, track productivity, conduct regular performance evaluations, and encourage ongoing learning.

• Manage and execute thorough quality assurance assessments for coding performed by both internal CDI staff and external vendor partners.

• Ensure adherence to official ICD-10-CM guidelines and risk adjustment models.

• Develop, implement, and sustain standard operating procedures (SOPs), audit workflows, scoring methodologies, and coding quality standards.

• Serve as a subject matter expert during external payer audits, including RADV, Medicare, and Commercial audits.

• Assist with chart selection, review, dispute documentation, and response to appeals.

• Assess the accuracy rates of third-party coding vendors against established service level agreements (SLAs).

• Provide feedback, identify error trends, and initiate corrective action plans.

• Convert QA audit findings into actionable insights and offer educational resources to internal CDI specialists and vendors.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• Bachelor’s Degree in healthcare management, nursing, or a related field, or an Associate Degree with relevant experience in CDI, coding, coding management, or HCC Risk Adjustment is required.

• A minimum of 4 years of HCC coding experience, with 2 years specifically concentrated on coding quality assurance, auditing, or compliance monitoring.

• Active professional credentials from AAPC and/or AHIMA are required (such as CRC, CCS, CPC, or CPMA).

• Extensive knowledge of ICD-10-CM coding, CMS Risk Adjustment guidelines, RADV audit rules, and clinical documentation requirements.

• CRC (Certified Risk Adjustment Coder) certification.

• Experience working within Value-Based Care (VBC) models, ACOs, or Advantage plans.

• Previous experience managing small teams or leading vendor oversight programs.

• Outstanding leadership, communication, and organizational abilities.

• Proficiency in EHR systems and encoder software.

🏝️ Benefits

• Flexible work schedules and opportunities for remote work are available for many positions.

• Health, dental, and vision insurance coverage paid up to 80% for employees, their dependents, and domestic partners.

• Comprehensive time-off plan, including 21 days of PTO in your first year.

• Two paid volunteer days and 11 paid holidays.

• 12 weeks of paid parental leave for all new parents.

• Six weeks of paid sabbatical after six years of service.

• Educational Assistant Program and Clinical Employee Reimbursement Program.

• 401(k) plan with up to 4% match.

• Stock options.

• A collaborative, inclusive, and remote-first culture.