QA I HCC/Risk Adjustment Coding (Seasonal)
About the position
The QA I, Clinical Ops position at Cotiviti, Inc. is a critical role within the Coding and Clinical Validation Audit team, specifically focused on risk adjustment coding. This position is designed to monitor and report on the accuracy of coding practices among assigned coders, ensuring that all code captures are accurate and meet the required standards. The QA will be responsible for reviewing a percentage of images coded by their assigned coders, providing feedback, and assisting in the remediation process for coders who do not meet the project benchmarks. This role is seasonal, expected to last approximately six months, starting at the end of May 2024 and continuing through January 2025, with the possibility of ongoing seasonal employment based on performance. The position offers flexible hours, with up to 40 hours available each week, although some required hours will be necessary during the first week of employment. In this role, the QA will ensure that the highest level of HCC mapped diagnosis codes is utilized for each date of service reviewed. They will communicate findings, errors, and suggestions to all staff to facilitate ongoing communication and efficient department operations. The QA will also conduct internal audits as necessary to support quality accuracy and respond to questions from individual coders through the Questions Queue. Regular interaction with other Cotiviti staff, including training and quality assurance teams, will be essential to clarify coding results and provide necessary training. The QA will also review internal system reports on the quality of work for all assigned Clinical Coder Specialists, ensuring that a 95% accuracy rate is maintained across the board.
Responsibilities
Monitor and report on the accuracy of all code captures on a percentage of images from assigned coders.
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Answer questions for coders through the Questions Queue or via email.
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Assist in the remediation process for coders below project benchmarks, including full image reviews.
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Provide Quality Assurance feedback to ensure a 95% coding accuracy rate is maintained.
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Review a defined percentage of work from Coder I and Coder II to ensure accuracy.
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Complete image reviews for proper HCC mapped diagnosis coding from various chart types.
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Document findings in the company data storage program.
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Communicate findings, errors, and suggestions to facilitate efficient department operations.
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Complete internal audits as necessary to support quality accuracy.
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Respond to questions via the 'Questions Queue' for individual coders.
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Review internal system reports on quality of work for assigned Clinical Coder Specialists.
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Communicate quality issues and trends to the Team Lead, Coding Manager, and Training Manager.
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Recommend additional training based on quality audit results for Coder I and Coder II.
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Develop action plans in collaboration with the Team Lead and Manager for quality improvement.
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Interact regularly with other Cotiviti staff to facilitate clarification and training on coding results.
Requirements
Experience in HCC/Risk Adjustment coding is required.
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Active coding certification through the AAPC or AHIMA (CPC, CRC, CCS, etc.) is required.
Nice-to-haves
Benefits
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