Hiring | Quality Analyst

Optum

3 - 6 years

7 - 10 Lacs

navi mumbai pune chennai

Posted:3 weeks ago| Platform:

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Skills Required

quality audit hcc coding quality assurance cpc certified aapc certification ahima certification

Work Mode

Work from Office

Job Type

Full Time

Job Description

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

Education and/or 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 is required

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