Senior Quality Assurance Specialist

2 days ago

Dallas, United States Robert Half Full time

Functional Role: Quality Assurance Coding Auditor

Start Date: ASAP – 1/20 or 1/27 with 2 weeks onboarding (Background check is required)

Duration: 6+ months

Remote / Onsite / Hybrid: 100% remote

Hourly Pay Rate: $60/hr

Job Details:

Successful contractor will possess extensive hospital billing (inpatient / outpatient), coding audit experience to help perform some Quality Assurance (QA) on quarterly audits we perform for one of our clients

Mandatory certifications are CCS (AHIMA) or CIC/COC combination certifications (AAPC)

Additional certifications like the CPC, CCS-P, CIRCC, CPMA are added bonuses and could also help on other clients/projects in the future

Also experience with Epic, 3M, Meditech, or One Content is needed for this client

Audit 10k records a year

250 coders that are contractors, USAI has team of 4-5 that audits the 250 coders

This assignment will be the QA of USAI

Auditing medical records, coding, clinical knowledge

End client has specific requirements

Comfortable getting into a medical record

Comfortable performing policy review


Detailed Job Summary:

This professional is tasked with ensuring the accuracy and compliance of coding auditor recommendations for medical coders' accounts, as well as validating the accuracy of coding auditors when no recommendations are made. In their role, they conduct a comprehensive review and validation of the coding auditor's recommendations, scrutinizing the appropriateness of diagnostic and procedural codes assigned by the medical coders based on the auditors' feedback. This ensures the highest level of coding accuracy, which is crucial for correct billing, optimal reimbursement, and minimizing the risk of audits and penalties from regulatory bodies. An equally important part of their job is to perform quality assurance checks on accounts where the coding auditor has made no recommendations. This involves independently auditing a selection of these accounts to confirm the accuracy of the original coding, thereby validating the coding auditor's judgment and ensuring no potential issues were overlooked. The Quality Assurance Auditor also works closely with the project manager, providing feedback on their review findings. This includes addressing any discrepancies or errors found during the review process, clarifying coding rules and guidelines along with hospital internal coding policies, and sharing information on how to improve coding accuracy and compliance. Additionally, this professional is responsible for keeping up-to-date with changes in these internal coding policies, coding standards, healthcare regulations, and compliance requirements. Their expertise and meticulous oversight help ensure that both the coding auditors' recommendations and their decisions to make no recommendations are accurate, contributing to the smooth and efficient operation of the organization's quarterly coding audits process.


Top 3 Keys:

1. Certification—Certified Coding Specialist (CCS) OR Certified Inpatient Coder (CIC)/Certified Outpatient Coder (COC) must have / Certified Professional Coder (CPC), Certified Coding Specialist – Physician-based (CCS-P), Certified Interventional Radiology Cardiovascular Coder (CIRCC), Certified Professional Medical Auditor (CPMA) nice to have

2. Extensive auditiing background strongly preferred—hospital or facility auditing

3. Epic or Meditech experience required


Software: Epic or Meditech

Excel skills/tools: Solid Excel

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