Certified Quality Assurance Specialists
4 weeks ago
Roles & Responsibilities –
- Possess knowledge on risk adjustment models – Medicare & Commercial.
- Should be well-versed in coding standards and guidelines, including ICD-10-CM guidelines, AHA coding clinic updates, and client-specific guideline requirements.
- Should be able to perform QA audits for multiple projects.
- Derive effective QA sampling & audit methodology for the projects assigned.
- Possess analytical skills to monitor & measure the quality trend in the coding projects.
- Perform root cause analysis, identify knowledge gaps, and conduct training to project team.
- Review scope document & guidelines for new clients before the start of the project and own pilot project delivery to meet client SLA on quality.
- Review & customize standard coding guidelines as needed.
- Identify error trends on client feedback & improve client experience by continuous improvements.
- Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors.
- Ability to respond to the internal coding queries with proper rationale.
- Follow external and internal compliance standards.
Education & Work Experience –
- Educational Background: Degree in Life Sciences or Medical/Paramedical Sciences
- Experience: Minimum 3+ years of experience HCC Risk Adjustment Coding.
- Certifications: Valid AAPC or AHIMA certification required
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