Coding Quality Assurance, QA Manager

🕒 Yesterday

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 10%

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Aledade, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2014

🏥 Healthcare

⚕️ Healthcare Insurance

🏢 Enterprise

Healthcare • Healthcare Insurance • Enterprise

Aledade, Inc. is a public benefit corporation that operates as the largest network of independent primary care practices in the United States. The company specializes in Accountable Care Organizations (ACOs), which help primary care practices and health centers improve patient outcomes and generate sustainable revenue through value-based care solutions. Aledade offers data insights, support, and business solutions to achieve sustainability and clinical autonomy. It collaborates with a wide range of healthcare providers, including primary care practices, community health centers, and network ACOs, ensuring improved quality of care and patient satisfaction. With operations in 45 states and affiliations with over 20,000 clinicians serving more than 2. 5 million patients, Aledade is committed to reducing care fragmentation and enhancing the overall quality of life for clinicians and patients alike.

📋 Description

• Lead, mentor, and manage a team of QA Specialists • Establish team goals, monitor productivity, conduct regular performance reviews, and foster continuous learning • Oversee and perform comprehensive quality assurance reviews for coding completed by internal CDI staff and external vendor partners • Ensure compliance with official ICD-10-CM guidelines and risk adjustment models • Design, implement, and maintain SOPs, audit workflows, scoring methodologies, and coding quality guidelines • Act as a subject matter expert during external payer audits, including RADV, Medicare, and Commercial audits • Assist with chart selection, review, dispute documentation, and appeal responses • Evaluate third-party coding vendor accuracy rates against established SLAs • Deliver feedback, identify trend errors, and drive corrective action plans • Translate QA audit findings into actionable insights and provide educational resources to internal CDI specialists and vendors • Perform other duties as assigned

🎯 Requirements

• Bachelor’s Degree in health care management, nursing or related field or an Associate Degree with relevant experience in CDI, coding, coding management, or HCC Risk Adjustment required • Minimum of 4 years of HCC coding experience with 2 years specifically focused on coding quality assurance, auditing, or compliance monitoring • Active professional credentials from AAPC and/or AHIMA required (such as CRC, CCS, CPC, or CPMA) • Deep mastery of ICD-10-CM coding, CMS Risk Adjustment guidelines, RADV audit rules, and clinical documentation requirements • CRC (Certified Risk Adjustment Coder) • Experience working within Value-Based Care (VBC) models, ACOs, or Advantage plans • Prior experience managing small teams or leading vendor oversight programs • Exceptional leadership, communication, and organizational skills • Proficiency with EHR systems and encoder software

🏖️ Benefits

• Flexible work schedules and the ability to work remotely are available for many roles • Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners • Robust time-off plan (21 days of PTO in your first year) • Two paid volunteer days and 11 paid holidays • 12 weeks paid parental leave for all new parents • Six weeks paid sabbatical after six years of service • Educational Assistant Program and Clinical Employee Reimbursement Program • 401(k) with up to 4% match • Stock options • Collaborative, inclusive and remote-first culture