Quality Supervisor Jobs

About The Position

Requirements

• Five years of ICD-10-CM and Hierarchical Condition Category (HCC) coding experience.
• Experience in CMS and HHS Risk Adjustment Data Validation Audits (RADV and HRADV).
• Prior experience supervising or managing people and/or projects, or indirectly leading teams.
• CPC and CRC certifications are required.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
• Knowledge of the healthcare industry.
• Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation, medical services billing, and healthcare reimbursement systems, including comprehensive understanding of ICD-10 and other coding submitted to the Health Plan by contracted facilities and providers.
• Extensive knowledge of CMS and HHS HCC Risk Adjustment coding, Medicaid CRG coding, and data validation requirements.
• Strong written and verbal communication, analytical, organizational, and time-management skills.
• Ability to recognize and properly oversee confidential health information.
• Demonstrated ability to use a variety of Electronic Medical Records (EMR) systems.
• Demonstrated experience in project completion, educational program development, and/or group presentations.
• Ability to work prolonged periods sitting and/or standing at a workstation and using a computer.
• Ability to work in a home office continuously for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Repetitive motion is required.

Nice To Haves

• Associate’s degree in a healthcare-related field.
• Other current coding certification from AAPC or AHIMA, such as CPC-H, CPC-I, CCS, RHIA, or RHIT.
• Certified Documentation Expert Outpatient (CDEO) certification.

Responsibilities

• Provide strategic oversight, supervision, and support to Risk Adjustment Quality Assurance Auditors, ensuring audit activities adhere to state, federal, and corporate standards.
• Direct and coordinate daily team operations to ensure coding accuracy, regulatory compliance, and consistent application of CMS, ICD-10-CM, and organizational guidelines.
• Oversee monthly internal coding quality audits and federal and state risk adjustment data validation audits, including IPM, CON RADV, and HRADV.
• Document and define audit project expectations and parameters in accordance with departmental, corporate, state, and federal deadlines.
• Work with the Risk Adjustment Coding Educator Manager and Training Lead to identify coding and audit education opportunities for external business partners and internal staff.
• Coach, mentor, and train audit staff; conduct performance evaluations, goal setting, and quarterly feedback conversations.
• Ensure audits comply with CMS guidelines, ICD-10-CM Official Coding Guidelines, risk adjustment coding standards, and organizational policies.
• Monitor audit quality, accuracy rates, and turnaround times, and assist with complex case reviews as needed.
• Serve as a subject matter expert in Risk Adjustment Audit and Coding, advising staff on audit and coding practices through discussion and project validation.
• Evaluate workloads and processes to maximize productivity and efficiency and meet deadlines; assist leadership with staff productivity and quality reporting, due dates, project expectations, and completion monitoring.
• Develop corrective action plans and training materials, deliver training as needed, and maintain staff and departmental quality and volume statistics and documentation.
• Provide backup risk adjustment quality assurance auditing and assist with day-to-day work as needed; execute audit projects supporting department strategy.
• Recommend and pursue process improvements to increase audit accuracy and productivity.
• Coordinate and perform RADV and other audits as requested.
• Provide regular written and oral project status reports to management, proactively identify risks, and report team and individual accomplishments, barriers, progress, and training needs to the Manager Risk Adjustment Coding and Auditing.
• Support the Lifetime Healthcare Companies’ mission and values, follow the Corporate Code of Conduct, and lead according to Lifetime Way values and beliefs.
• Protect member privacy in accordance with corporate privacy policies and procedures.
• Maintain knowledge of relevant legislative and regulatory mandates and ensure activities comply with them.
• Conduct regular staff meetings and distribute and provide education on departmental and Ethics/Compliance information in a timely manner.
• Maintain regular and reliable attendance.
• Perform other functions as assigned by management.

Benefits

• Group health insurance may be included in the total rewards package.
• Dental insurance may be included in the total rewards package.
• Retirement plan may be included in the total rewards package.
• Wellness program may be included in the total rewards package.
• Paid time away from work may be included in the total rewards package.
• Paid holidays may be included in the total rewards package.