Quality Assurance Manager
Core
Own the quality assurance program for retrospective coding and auditing operations, including policies, SOPs, team direction, and findings production.
Role type
Senior IC Quality Assurance Manager (Medical Coding/Risk Adjustment)
Builds
QA policies, SOPs, accuracy standards, and process changes for retrospective coding and audit operations.
Domain
Healthcare / Medical Coding / Risk Adjustment
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
ICD-10-CM coding guidelines, AAPC/AHIMA certification (CPC/CRC/CCS/CCS-P), medical record abstraction, vendor management, QA policy development, AI-assisted coding validation
Preferred skills
CMS risk adjustment models, off-shore team management, NLP/CAC tool auditing, audit sampling methodology
Technologies
AI-assisted coding tools, NLP, CAC, risk adjustment tooling
Responsibilities
Oversee offshore FDR vendor team of QA Reviewers; maintain QA policies and SOPs; perform QA reviews of escalated and high-risk charts; run monthly/quarterly QA Scorecard process; identify coding trends and convert to education/process changes; partner with technology teams on risk adjustment tooling; support retrospective coding and audits by abstracting medical records.
Seniority
Senior, hands-on IC
