Certified Quality Assurance Specialists

4 weeks ago

Rajkot, India Skillra Technologies Full time

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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