Quality Assurance Manager

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

📋 Description

• Act as a specialist in ICD-10-CM coding protocols, AHA Coding Clinic recommendations, and internal risk adjustment policies.

• Supervise an offshore FDR vendor team of QA Reviewers, ensuring adherence to accuracy and productivity benchmarks, conducting performance evaluations, and managing workload distribution.

• Report staffing, training, and quality deficiencies to vendor management.

• Develop and uphold QA policies and Standard Operating Procedures (SOPs) related to coding quality, retrospective coding, and audit functions.

• Organize QA review coverage and representative sampling across both internal staff and vendor teams.

• Conduct QA assessments of escalated, disputed, and high-risk charts, and resolve any coding discrepancies.

• Manage the monthly and quarterly QA Scorecard processes and ensure follow-through on remediation actions.

• Recognize documentation and coding trends, and transform findings into educational materials, job aids, or procedural revisions.

• Evaluate QA team accuracy and integrate insights into the QA methodology.

• Collaborate with vendor leadership to establish quality expectations, corrective actions, and escalation processes.

• Address coding inquiries and maintain a log of questions and answers.

• Work alongside technology and analytics teams on risk adjustment tools, which include AI-assisted coding solutions.

• Outline QA requirements, test software releases and enhancements, and provide input on technology design and effectiveness.

• Develop and oversee production monitoring for tools, tracking performance variations and error trends.

• Assist with retrospective coding and audits by abstracting medical records or ICD-10 codes for CMS submissions.

• Suggest process improvements and compile departmental reports.

• Serve as a voting subject matter expert (SME) on risk adjustment coding within Devoted’s Coding Steering Workgroup.

• Manage patient data in compliance with HIPAA Privacy and Security regulations.

• Perform other related tasks as necessary.

⛳️ Requirements

• Valid coding certification recognized by AAPC or AHIMA; such as CPC, CRC, CCS, or CCS-P.

• A minimum of 7 years of recent, relevant experience in medical record documentation review, diagnosis coding, and/or auditing, particularly in risk adjustment coding.

• Proven experience in leading the development and presentation of accuracy or performance metrics to production coders or management.

• Strong understanding of ICD-10-CM coding guidelines and regulations.

• Capability to read medical records and abstract clinical diagnosis codes from the documentation.

• Proficiency in CMS risk adjustment models.

• Experience in managing or overseeing vendor and/or offshore coding teams.

• Familiarity with validating or auditing AI-assisted, NLP, CAC, or other automated chart review technologies.

• Experience in drafting or significantly revising QA policies, SOPs, or audit sampling methodologies.

• Excellent communication, organizational, and interpersonal skills, including the ability to format and present QA Review results and findings to staff and vendor leaders.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with minimal or no premiums.

• Generous paid time off.

• Monthly stipend of $100 for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all positions, excluding Director and higher roles.

• Commission eligibility for Sales positions.

• Parental leave program.

• 401K program.