Coding Quality Assurance (QA) Manager, Remote

Team Leadership & Oversight: Lead, mentor, and manage a team of QA Specialists. Establish team goals, monitor productivity, conduct regular performance reviews, and foster a culture of continuous learning.

Quality Audits: Oversee and perform comprehensive quality assurance reviews for coding completed by internal CDI staff and external vendor partners, ensuring compliance with official ICD-10-CM guidelines and risk adjustment models.

SOP & Guideline Development: Design, implement, and maintain standard operating procedures, audit workflows, scoring methodologies, and coding quality guidelines across the organization.

Payer Audit Support: Act as a key subject matter expert (SME) during external payer audits (e.g., RADV, Medicare, Commercial). Assist with chart selection, review, dispute documentation, and appeal responses.

Vendor Management: Evaluate third-party coding vendor accuracy rates against established SLAs. Deliver constructive feedback, identify trend errors, and drive corrective action plans when necessary.

Education & Feedback Loops: Translate QA audit findings into actionable insights. Provide structured feedback and target educational resources to internal CDI specialists and vendors to prevent recurring errors.

Other duties as assigned

Bachelor’s Degree in health care management, nursing or related field or an Associate Degree with relevant experience in CDI, coding, coding management, or HCC Risk Adjustment required.

Minimum of 4 years of HCC coding experience with 2 years specifically focused on coding quality assurance, auditing, or compliance monitoring.

Active professional credentials from AAPC and/or AHIMA required (such as CRC, CCS, CPC, or CPMA).

Deep mastery of ICD-10-CM coding, CMS Risk Adjustment guidelines, RADV audit rules, and clinical documentation requirements.