QA I – Coding Operations
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Job Description
QA specialist auditing HCC medical coding for Cotiviti’s risk adjustment operations. Coaching coders, reviewing accuracy, and supporting compliance and remediation.
Responsibilities:
- 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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