Job Title: Quality Assurance Coder/Auditor Location: Phoenix, AZ (Hybrid, Required to Travel into the office 1 x per week) Duration: 6 Months (possibility of extension or conversion) Department: Medicare/ Medicaid Purpose The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, the Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at‑risk code identification and risk mitigation. This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at‑risk single occurrences of HCCs and OIG targets. Deletions will be submitted for unsupported/invalid diagnoses. This analysis combined with QA findings and EDPS claims errors will drive the content and audience for provider education. The Quality Assurance Coder/Auditor will perform medical record reviews and abstract codes to the highest specificity effectively from medical records based on the documentation provided. The coder/auditor is responsible for ensuring diagnosis codes selected come from a face‑to‑face visit with a valid risk‑adjustable provider. The coder/auditor will perform QA for vendors and other submitters of supplemental HCC data and provide educational feedback relevant to the same. Responsibilities Comprehensive understanding of HCC coding rules, regulations and methodology Review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct coding, and recommend best coding practices and improvements Determine valid encounters, including face‑to‑face, legibility and valid signature, according to Medicare Managed Care requirements Track QA audits and send out monthly updates to vendor and management team. Updates include report findings and recommendations regarding closing healthcare gaps, medical record documentation, coding, and additional educational training to management. The goal is >95% accuracy in QA audits Accurately and efficiently conduct medical record review/abstraction services Develop effective provider/coder education program in support of risk mitigation analysis Travel to physician offices, conduct on‑site educational training on how to close identified health‑care gaps, accurately document in medical record, and submit claims with correct coding. Track educational training sessions by date, provider, topic, number of attendees, etc. Other duties as assigned Maintain current knowledge of the Medicare Managed Care Manual, Chapter 7 – Risk Adjustment and Medicare outpatient billing systems/processes Maintain coding certification and stay current with the numerous changes in risk adjustment methodologies The position requires a full‑time work schedule. Full‑time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. Required Experience 5 years of professional medical coding experience, with at least 3 years of HCC coding experience. Advanced knowledge of coding guidelines and coding in healthcare products. Required Certifications Certified Coding Specialist – Physician Based (CCS‑P), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Outpatient Coder (COC) credential Education requirement High school diploma or GED in general field of study Ideal years of experience 5+ years #J-18808-Ljbffr
Quality Assurance Coder/Auditor • Phoenix, AZ, United States
Staff Experts, LLC is a highly specialized full-service Staffing & Recruiting Firm.We specialize in staffing in the areas of Engineering, Construction Management, Manufacturing, Information Technol... Show more
The Quality Assurance Supervisor ensures the timely and effective implementation of standard operating procedures, policies, and activities to maintain the quality of manufactured products at the d... Show more
Commercial Property and Casualty Underwriting Quality Assurance Analyst - Remote Opportunity in AZ, PhoenixWe are seeking a Commercial Property & Casualty Quality Assurance Analyst to join our ... Show more
The Assurance Senior will be responsible for coordinating the day-to-day "in-charge" duties of planning, fieldwork and "wrap-up" to include the preparing of financial statements with disclosures, a... Show more
QA TechnicianWe are seeking a detail-oriented QA Technician to support quality assurance activities within a semiconductor manufacturing environment.This role involves performing inspections, tests... Show more
Job Title:Quality Assurance Plant Monitor/Truck Sampler-De-linterJob Location:Bapchule, AZJob Duration:12 Months on W2This position is responsible for assisting the Quality Control group to conduct... Show more
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.As a Dasher, you’ll stay busy with a var... Show more
Manager of Quality Assurance & Control (QA/QC)Location :Tempe, AZ, Hoboken NJ or remoteDepartment :OperationsReports to :Director of Manufacturing OperationsAbout UsQuantum Computing Inc.QCi) (... Show more
February 2026 Update GL-5/7 grade levels.Border Patrol Agent (BPA) – in the Federal Security and Public Safety Sector (Entry Level).If you’re looking for “just a job,” then stop reading right now.B... Show more
Consultative CoderThe Consultative Coder provides medical coding expertise to support clinical staff (physicians and advanced practice providers) to ensure the documentation within medical records ... Show more
Medical Coder-Aleca Home HealthAs our company expands, we are actively seeking seasoned Medical Coders.If you're prepared to elevate your career and reap the rewards of an unparalleled compensation... Show more
Job Title: Quality Inspector Department: Quality AssuranceReports To: Quality Inspection ManagerDuties and Responsibilities: Include the following; other duties may be assigned.Receives and inspect... Show more
Professional development is a key focus at Deloitte, offering opportunities for growth from entry-level to senior leadership roles.We provide a variety of learning experiences and formal developmen... Show more
Duration: 6 months possible extension possible conversion Pay rate: $21/hr Location: Chandler AZ.Call monitoring quality assurance experience.Quality Assurance: Covers jobs responsible for review... Show more
AML/ KYC Quality Assurance Lead, Digital Asset Banking.The AML/KYC Quality Assurance Lead is a first line of defense (1LOD) control role responsible for establishing, executing, and enhancing the q... Show more
Health Insurance Compliance And Quality Assurance Associate.Are you ready to turn your attention to detail into a meaningful career with Get Me Healthcare in Scottsdale, AZ? We're hiring a full-tim... Show more
Financial Crimes Quality Assurance Analyst.At Pathward, we take tremendous pride in our purpose to create financial inclusion for all.We are a financial empowerment company that works with innovato... Show more
Compensation: Varies per assignment.Location: Remote (USA) Company: ProductReviewJobs Thank you for your interest in becoming a Paid Product Tester.This opportunity is for completing market res... Show more
Program Lead, Payor Connections/Interoperability.We're hiring a Program Lead, Payor Connections/Interoperability to join our Risk Adjustment team.Oscar is the first health insurance company built a... Show more
More Information about this Job:.Nurse FULL-TIME Opportunity in Central, Az.Critical Care Transport (CCT) Nurse.Provide care requirements aligned within the Registered Nurse scope of practice as de... Show more
