Certified Quality Assurance Specialists

Roles & Responsibilities –

Possess knowledge on risk adjustment models – Medicare & Commercial.

Should be well-versed in coding standards and guidelines, including ICD-10-CM guidelines, AHA coding clinic updates, and client-specific guideline requirements.

Should be able to perform QA audits for multiple projects.

Derive effective QA sampling & audit methodology for the projects assigned.

Possess analytical skills to monitor & measure the quality trend in the coding projects.

Perform root cause analysis, identify knowledge gaps, and conduct training to project team.

Review scope document & guidelines for new clients before the start of the project and own pilot project delivery to meet client SLA on quality.

Review & customize standard coding guidelines as needed.

Identify error trends on client feedback & improve client experience by continuous improvements.

Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors.

Ability to respond to the internal coding queries with proper rationale.

Follow external and internal compliance standards.

Education & Work Experience –

Educational Background : Degree in Life Sciences or Medical / Paramedical Sciences

Experience : Minimum 3+ years of experience HCC Risk Adjustment Coding.

Certifications : Valid AAPC or AHIMA certification required