Quality Assurance Manager

🔥 14 minutes ago

🇺🇸 United States – Remote

💵 $73k - $114k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 0%

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Serve as an expert on ICD-10-CM coding guidelines, AHA Coding Clinic guidance, and internal risk adjustment guidance • Oversee an offshore FDR vendor team of QA Reviewers, including accuracy and productivity standards, performance review, and volume allocation • Escalate staffing, training, and quality gaps to vendor management • Own and maintain QA policies and SOPs for coding quality, retrospective coding, and audit operations • Plan QA review coverage and representative sampling across internal staff and vendors • Perform QA reviews of escalated, disputed, and high-risk charts and resolve coding disagreements • Own monthly and quarterly QA Scorecard processes and remediation follow-through • Identify documentation and coding trends and convert findings into education, job aids, or process changes • Measure QA team accuracy and incorporate findings into the QA process • Partner with vendor leadership on quality expectations, corrective action, and escalation • Resolve coding questions and maintain the questions-and-answers log • Partner with technology and analytics teams on risk adjustment tooling, including AI-assisted coding • Define QA requirements, test releases and enhancements, and provide feedback on technology design and performance • Build and run production monitoring for tools, tracking performance drift and error patterns • Support retrospective coding and audits by abstracting medical records or ICD-10 codes for CMS submission • Recommend process improvements and prepare department reporting • Serve as a voting risk adjustment coding SME on Devoted’s Coding Steering Workgroup • Handle patient data ethically under HIPAA Privacy and Security rules • Perform other related duties as required

🎯 Requirements

• Current relevant coding certification recognized by AAPC or AHIMA; examples include CPC, CRC, CCS, CCS-P • 7+ years of recent and related experience in medical record documentation review, diagnosis coding, and/or auditing, including risk adjustment coding • Experience leading development and presentation of accuracy or performance results to production coders or management • Sound knowledge of ICD-10-CM coding guidelines and regulations • Ability to read medical records and abstract clinical diagnosis codes from documentation • Expertise in CMS risk adjustment models • Experience managing or overseeing vendor and/or off-shore coding teams • Experience validating or auditing AI-assisted, NLP, CAC, or other automated chart review technology • Experience writing or substantially revising QA policies, SOPs, or audit sampling methodology • Communication, organizational, and interpersonal skills, including formatting and presenting QA Review results and delivering findings to staff and vendor leaders

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Commission eligibility for Sales roles • Parental leave program • 401K program