Quality Assurance Specialist

Primary Responsibilities:

• 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
• Be able to respond to the internal coding queries with proper rationale
• Follow external and internal compliance standards
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Educational Background: Degree in Life Sciences or Medical/Paramedical Sciences
• Certifications: Valid AAPC or AHIMA certification is required
• Experience: 3+ years of experience HCC Risk Adjustment Coding
• Knowledge on risk adjustment models Medicare & Commercial
• Well-versed in coding standards and guidelines, including ICD-10-CM guidelines, AHA coding clinic updates, and client-specific guideline requirements