QA I – Coding Operations

Job not on LinkedIn

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $25 - $32 / hour

⏱ Part Time

🟢 Junior

🔧 QA Engineer (Quality Assurance)

🚫👨‍🎓 No degree required

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Monitor and report the accuracy of coding performed by Cotiviti and third-party partner coders • Provide direct coaching and feedback to coders • Conduct QA and audit reviews and support remediation for risk adjustment coding services • Liaise between Coder I, Coder II, and the Team Lead to ensure coding is complete and accurate • Review a defined percentage of Coder I and Coder II work against quality standards • Review charts and encounters for proper HCC-mapped diagnosis coding across physician, facility, and non-facility chart types • Review prospective, concurrent, and retrospective coding • Ensure coding follows client-specific and industry-standard guidelines and accurately reflects medical-record documentation • Communicate findings, errors, suggestions, quality issues, and trends to coders, QA II, team leads, and managers • Complete internal audits and review quality reports on daily, weekly, monthly, quarterly, and yearly schedules • Recommend additional training based on quality audit results, including for coders below the 95% accuracy rate • Develop action plans with Team Leads and Managers and report progress • Respond to coder questions through the Questions Queue • Use Cotiviti training tools and coding library • Complete annual performance-plan responsibilities, special projects, and other assigned duties

🎯 Requirements

• High School diploma required; Bachelor's degree preferred • Clinical background preferred • Coding certification required through AAPC or AHIMA (CPC, CRC, CCS, etc.) • Expertise in medical record auditing, particularly in HCC mapped diagnosis coding • Minimum of one to three years HCC coding experience • Demonstrated high performance in meeting or exceeding production and quality goals • Adherence to official coding guidelines, coding clinic determinations, client specific coding guidelines, CMS and other regulatory compliance guidelines and mandates • Ability to read and understand medical record documentation • Ability to identify trends in coding and documentation errors, including over- and under-coding • Excellent written and verbal skills, including coaching and interpersonal skills • Strong knowledge of medical terminology and anatomy and physiology • Skilled in organization and customer service • Computer and technology literate • Analytical and problem solving skills • Ability to manage and meet deadlines • Flexibility to provide assistance in emergent situations and/or projects • Must participate in required training • Must abide by HIPAA and associated patient confidentiality requirements • Must be able to perform duties with or without reasonable accommodation • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance

🏖️ Benefits

• Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law • Virtual interviews • Reasonable accommodation where applicable • Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance required for remote work

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