Hiring Medical Coding Quality Assurance Specialist For

2 weeks ago


Pune, Maharashtra, India Optum Full time

Hi,

Warm greetings from Optum

We are looking for highly talented, dynamic medical coding professionals for Quality Assurance Specialist position.

Role & 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.

Preferred candidate profile

  • Educational Background: Degree in Life Sciences or Medical/Paramedical Sciences
  • Experience: Min 3+ years of experience HCC Risk Adjustment Coding with 6 Months experience in Quality Sampling & Quality Auditing
  • Certifications: Valid AAPC or AHIMA certification is required

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