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 –