Clinical Operations QA Specialist

Summary

Join Reveleer as a Clinical QA Specialist and ensure all clinical resources meet quality standards. You will provide support to the clinical QA and Training team, focusing on quality and productivity. The ideal candidate is detail-oriented, able to work independently and collaboratively, and demonstrates initiative in designing new QA protocols and policies. Responsibilities include completing overreads of coder chases, communicating coding error trends, assisting coders with queries, creating and maintaining quality control activities, identifying outliers needing retraining, pulling reports to understand error trends, and collaborating with QA teams. The role requires a professional coding certificate, minimum 5 years of coding experience with Medicare and Commercial Risk Adjustment knowledge, strong computer skills, and commitment to patient confidentiality. Reveleer offers competitive compensation.

Requirements

• Must have a professional coding certificate through AHIMA/AAPC (CRC Certification preferred)
• Minimum of 5 years 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 confidentiality of patient health information
• Professional, articulate and able to work independently

Responsibilities

• Completes overread of chases for coders in production and provides support in completing initial QA process during onboarding
• Communicates with and provides feedback to the Training and QA team of coding error trends and assist in creating action plans to mitigate QA discrepancies
• Assists coders in resolving coding queries based on Reveleer Coding Guidelines, AHA Coding Clinics, CMS Coders Guidance on Medical Review
• Create and maintain quality control activities: Bi-monthly quality check on performance, monthly quality assurance reviews, keeping track of QA scores and make sure that all corrections are done in a timely manner
• During the bi-monthly quality checks – able to identify outliers that needs retraining and set action plans and communicated either on one-on-one or group teaching in coordination with the training team
• Pulls reports to better understand error trends and present to internal team for deliberation
• Collaborate and consult effectively with all levels of the QA teams to ensure adherence to policies and procedures
• Well-versed and Knowledgeable on Microsoft Office applications (Excel, Word, Powerpoint) as well as Adobe Pro and use these applications to handle communication within the clinical team
• Additional duties as necessary to meet our obligations to our customers

Benefits

Compensation: $32.25 / hour