[Hiring] Quality Assurance Manager @Devoted Health

Role Description

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.

• 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 or facilitate further escalation.
• Turn findings into education and process changes that raise coding accuracy across the department.
• Inform how technology is used to assist this work in accordance with our acceptable use policy.

Qualifications

• Current relevant coding certification recognized by AAPC or AHIMA (e.g., 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.

Requirements

• 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.
• Own and maintain Devoted’s QA policies and SOPs for coding quality, retrospective coding, and audit operations.
• Plan QA review coverage and sampling across internal staff and vendors.
• Perform QA reviews of escalated, disputed, and high-risk charts.
• Own the monthly and quarterly QA Scorecard process.
• Identify documentation and coding trends across reviewers and vendors.
• Run the review of individual QA work to measure the QA team’s accuracy.
• Partner with vendor leadership on quality expectations and corrective action.
• Own timely resolution of coding questions from sources coding on behalf of Devoted.
• Partner with technology and analytics teams on risk adjustment tooling.
• Build and run monitoring for tools in production.
• Support retrospective coding and audits by abstracting medical records or ICD-10 codes for submission to CMS.
• Recommend process improvements and prepare department reporting.
• Serve 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.
• Perform other related duties as required.

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.
• And more...