Clinical Operations QA Specialist

Reveleer

4d•$33 - $34•Remote

About The Position

The Clinical Operations QA Specialist monitors clinical resources to ensure they meet organizational quality standards and supports the Clinical QA and Training team in achieving quality and productivity outcomes. The role works independently while collaborating with team members and staff, and may contribute to designing QA protocols and policies within clinical operations. It also serves as a subject matter resource and provides support to staff throughout the organization. The specialist reviews coder work, supports onboarding QA, identifies coding error trends, and helps develop action plans to address quality discrepancies. The role maintains recurring quality-control and assurance activities, tracks QA scores, identifies outliers requiring retraining, and shares trend reports with internal teams. It also supports coders with coding queries and works with QA teams to promote adherence to policies and procedures.

Requirements

Professional coding certification through AHIMA or AAPC.
At least 5 years of coding experience, with specific knowledge of Medicare and Commercial Risk Adjustment, such as Hierarchical Condition Category (HCC).
Strong computer skills and high-speed internet access at home.
Commitment to maintaining the confidentiality of patient health information.
Professional and articulate, with the ability to work independently.
Skilled in Microsoft Office applications, including Excel, Word, and PowerPoint.

Responsibilities

Complete overreads of production coder chases and support the initial QA process during onboarding.
Communicate coding error trends to the Training and QA team and assist in creating action plans to mitigate QA discrepancies.
Assist coders in resolving coding queries using Reveleer Coding Guidelines, AHA Coding Clinics, and CMS Coders Guidance on Medical Review.
Create and maintain quality-control activities, including bi-monthly performance checks, monthly quality assurance reviews, tracking QA scores, and ensuring corrections are completed promptly.
Identify outliers requiring retraining during bi-monthly quality checks, develop action plans, and communicate them through individual or group teaching in coordination with the training team.
Pull reports to analyze error trends and present findings to the internal team for deliberation.
Collaborate and consult with QA teams at all levels to ensure adherence to policies and procedures.
Use Microsoft Office applications and Adobe Pro for communication within the clinical team.
Perform additional duties as necessary to meet customer obligations.