Hiring Medical Coding Quality Assurance Specialist For Optum !!

Optum

3 - 8 years

4 - 9 Lacs

pune

Posted:1 month ago| Platform:

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Skills Required

root cause analysis quality audit rca quality tools quality assurance corrective action hcc aha icd quality control

Work Mode

Hybrid

Job Type

Full Time

Job Description

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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