Coding Quality Assurance Manager

Job Description

A bit about this role:

We are hiring a Quality Assurance Manager to support the QA function within Devoted’s Risk Adjustment organization. This person owns the quality assurance program for our retrospective coding and auditing operations: the policies and SOPs behind it, the team that runs it, and the findings it produces. You will direct the work of a team of QA Reviewers, own the QA relationship with internal operational leaders and vendor partners (including AHS off-shore coding teams), review escalated charts yourself or facilitate further escalation, and turn findings into education and process changes that raise coding accuracy across the department. You will also inform how technology is used to assist this work in accordance with our acceptable use policy.

Your Responsibilities and Impact will include:

• 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: set accuracy and productivity standards, review performance against them, and adjust volume allocation based on results

• Escalate staffing, training, and quality gaps to vendor management, which owns hiring, onboarding, and day-to-day supervision

• Own and maintain Devoted’s QA policies and SOPs for coding quality, retrospective coding, and audit operations (operational and subject matter owner; subject matter owner for the others)

• Plan QA review coverage and sampling across internal staff and vendors, including AHS off-shore coding teams, so that samples are representative and review volumes are met

• Perform QA reviews of escalated, disputed, and high-risk charts, and serving as the internal authority on coding disagreements the team cannot resolve; ensuring diagnoses selected for review are appropriate, accurate, and supported by clinical documentation

• Own the monthly and quarterly QA Scorecard process: accuracy of the findings, delivery to Risk Adjustment leadership, coders, and vendor leaders during meetings, and follow-through on remediation plans

• Identify documentation and coding trends across reviewers and vendors, present them to department leadership, and convert them into education, job aids, or process changes

• Run the review of individual QA work so the QA team’s own accuracy is measured, and incorporating material findings into the QA process going forward

• Partner with vendor leadership on quality expectations, corrective action, and escalation when performance does not meet standard

• Own timely resolution of coding questions from sources coding on behalf of Devoted, and maintaining the log of questions and answers as outlined by policy or procedure

• 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 design and performance, within acceptable use policies

• Build and run monitoring for tools in production, tracking performance drift and error patterns concentrated in specific conditions, chart types, providers, or member populations

• Support retrospective coding and audits by abstracting medical records or ICD-10 codes for submission to CMS when volume or complexity requires it

• Recommend process improvements and preparing department reporting so productivity and quality goals are met or exceeded and operational efficiency is optimized

• Serving as a voting risk adjustment coding SME member on Devoted’s Coding Steering Workgroup

• Act in an ethical manner as required under HIPAA’s Privacy and Security rules, handling patient data with uncompromised adherence to the law, including what member data may be sent to which vendor systems

• Perform other related duties as required

Required skills and experience:

• Current relevant coding certification recognized by AAPC or AHIMA. Examples of relevant certifications 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 to meet regulatory, compliance, and internal policy requirements, and the ability to read medical records and abstract clinical diagnosis codes from documentation

Desired skills and experience:

• Expertise in CMS risk adjustment models

• Experience managing or overseeing vendor and/or off-shore coding teams

• Experience validating or auditing AI-assisted, NLP, or computer-assisted coding (CAC) tools, 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

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Salary Range: $73,000- $114,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• 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

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.