Cotiviti · 10 hours ago
QA I HCC/Risk Adjustment Coding
United States
Full-time
Remote
Entry Level
$25/hr - $32/hr
1+ years expCotiviti is a healthcare technology company focused on improving patient outcomes and reducing costs. The QA I, Clinical Ops position is responsible for monitoring the accuracy of coding by the Clinical Validation Audit team and assisting coders with quality assurance feedback. This role involves reviewing coding work, conducting audits, and providing training recommendations to ensure high accuracy in HCC coding.
Information Technology & Services
Responsibilities
Provides Quality Assurance feedback by working as a liaison between Coder I, Coder II and the Team Lead to ensure 95% coding accuracy. Reviews a defined percentage of the Coder I and Coder II work to ensure a 95% accuracy rate is maintained. This is for new hires as well as existing staff
100% of the work is reviewed for a new Hire until they have a consistent 95% accuracy rate
No more than 10% of the work is reviewed for Coder I, Coder II once they have tested at 95% quality
Completes image review for proper HCC mapped diagnosis coding from various chart types (physician, Facility, non – Facility). Ensures that the highest level of HCC mapped diagnosis code was utilized in each date of service reviewed and documentation of findings in company data storage program. Professionally communicates finds, errors, and any suggestions to all staff in order to facilitate on-going communications and efficient department operations
Completes internal audits as necessary to support quality accuracy
Responds to questions via the ‘Questions Queue’ for individual coders
Reviews internal system reports on quality of work for all assigned Clinical Coder Specialists. These reports are reviewed daily, weekly, monthly, quarterly and yearly as needed
Communicate quality issues and trends to the Team lead, Coding Manager and Training Manager
Recommend additional training based on results of the quality audit for those Coder I and Coder II where they fall behind the 95% accuracy rate
Develop an action plan in collaboration with the Team Lead and Manager as needed with regard to improvement in the quality of work for a Coder I or II and reports progress to the Team Lead
Regular interaction with other Cotiviti staff, such as training and quality assurance to facilitate clarification and/or training on coding results
May have occasional special projects that will entail a full coding review
Professionally communicates finds, errors, and any suggestions to Team Lead to facilitate on-going communications and efficient department operations as part of a continuous improvement process
Utilize Cotiviti training tools and coding library for questions
Completes all responsibilities as outlined on annual Performance Plan
Completes all special projects and other duties as assigned
Must be able to perform duties with or without reasonable accommodation
Qualification
Required
High School diploma required
Coding certification required through AAPC or AHIMA (CPC, CRC, CCS, etc.)
Experience in HCC/Risk Adjustment coding is required
Minimum of one to three years HCC coding experience
Demonstrated greater than 95% accuracy in HCC coding work
Adherence to official coding guidelines, coding clinic determinations, client specific coding guidelines, CMS and other regulatory compliance guidelines and mandates
Ability to read and understand medical record documentation
Must be able to identify trends in coding and documentation errors, to include over and under-coding
Excellent written and verbal skills to include coaching and interpersonal skills
Strong knowledge of medical terminology and anatomy and physiology
Skilled in organization and customer service
Computer and technology literate
Analytical and problem solving skills
Ability to manage and meet deadlines
Must remain flexible to provide assistance in any emergent situations and/or projects
Must participate in any required training
Must abide by all HIPAA and associated patient confidentiality requirements
Preferred
Bachelor's degree preferred
Clinical background preferred, but not required
Benefits
This role is eligible for discretionary bonus consideration.
Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.
Company
Cotiviti
Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States.
5001-10000 employees
H1B Sponsorship
Cotiviti has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (165)
2024 (118)
2023 (90)
2022 (102)
2021 (72)
2020 (67)
Funding
Current Stage
Late StageLeadership Team
Adam Gilbert
Director, Interoperability Operations and Partnerships
Chris McIntyre
Sr. Program Manager, RQNC Operations
Recent News
2024-04-07
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