CotivitiCO

QA I Coding Operations

Cotiviti is a solutions and analytics company that leverages clinical and financial datasets to provide insights into the performance of the healthcare system, focusing on payment accuracy, risk adjustment, quality improvement, and consumer engagement. It also serves the retail industry with data management and recovery audit services.

Cotiviti

Employee count: 5000+

Salary: 62k-65k USD

United States only

Overview

The QA I, Clinical Ops position works with the Coding & Clinical Validation Audit team focused on risk coding. The QA position monitors & reports on the accuracy of all code captures on a % of all images of their assigned coders. This position also answers all questions for their coders through the Questions Queue or via email. QA is also responsible for assisting in the remediation for their coders which include full image review of all images coded prior to release to ensure accuracy of image, for any coder below project benchmark.

Responsibilities

The QA I, Clinical Ops position works with the Coding & Clinical Validation Audit team focused on risk coding. The QA position monitors & reports on the accuracy of all code captures on a % of all images of their assigned coders. This position also answers all questions for their coders through the Questions Queue or via email. QA is also responsible for assisting in the remediation for their coders which include full image review of all images coded prior to release to ensure accuracy of image, for any coder below project benchmark.

  • Provides Quality Assurance feedback by working as a liaison between Coder I, Coder II and the Team Lead to ensure 95% coding accuracy. Reviews a defined percentage of the Coder I and Coder II work to ensure a 95% accuracy rate is maintained. This is for new hires as well as existing staff.
    • 100% of the work is reviewed for a new Hire until they have a consistent 95% accuracy rate.
    • No more than 10% of the work is reviewed for Coder I, Coder II once they have tested at 95% quality.
  • Completes image review for proper HCC mapped diagnosis coding from various chart types (physician, Facility, non – Facility). Ensures that the highest level of HCC mapped diagnosis code was utilized in each date of service reviewed and documentation of findings in company data storage program. Professionally communicates finds, errors, and any suggestions to all staff in order to facilitate on-going communications and efficient department operations.
  • Completes internal audits as necessary to support quality accuracy.
  • Responds to questions via the ‘Questions Queue’ for individual coders.
  • Reviews internal system reports on quality of work for all assigned Clinical Coder Specialists. These reports are reviewed daily, weekly, monthly, quarterly and yearly as needed.
  • Communicate quality issues and trends to the Team lead, Coding Manager and Training Manager.
  • Recommend additional training based on results of the quality audit for those Coder I and Coder II where they fall behind the 95% accuracy rate.
  • Develop an action plan in collaboration with the Team Lead and Manager as needed with regard to improvement in the quality of work for a Coder I or II and reports progress to the Team Lead.
  • Regular interaction with other Cotiviti staff, such as training and quality assurance to facilitate clarification and/or training on coding results.
  • May have occasional special projects that will entail a full coding review.
  • Professionally communicates finds, errors, and any suggestions to Team Lead to facilitate on-going communications and efficient department operations as part of a continuous improvement process.
  • Utilize Cotiviti training tools and coding library for questions.
  • Completes all responsibilities as outlined on annual Performance Plan.
  • Completes all special projects and other duties as assigned.
  • Must be able to perform duties with or without reasonable accommodation.

Qualifications

  • High School diploma required, Bachelor's degree preferred.
  • Clinical background preferred, but not required.
  • Coding certification required through AAPC or AHIMA (CPC, CRC, CCS, etc.).
  • Expertise in medical record auditing, particularly in HCC mapped diagnosis coding.
  • Minimum of one to three years HCC coding experience.
  • Demonstrated greater than 95% accuracy in HCC coding work.
  • Adherence to official coding guidelines, coding clinic determinations, client specific coding guidelines, CMS and other regulatory compliance guidelines and mandates.
  • Ability to read and understand medical record documentation.
  • Must be able to identify trends in coding and documentation errors, to include over and under-coding.
  • Excellent written and verbal skills to include coaching and interpersonal skills.
  • Strong knowledge of medical terminology and anatomy and physiology.
  • Skilled in organization and customer service.
  • Computer and technology literate.
  • Analytical and problem-solving skills.
  • Ability to manage and meet deadlines.
  • Must remain flexible to provide assistance in any emergent situations and/or projects.
  • Must participate in any required training.
  • Must abide by all HIPAA and associated patient confidentiality requirements.
  • For the safety of our employees and those considering employment with Cotiviti, we are currently conducting all interviews virtually.

Mental Requirements:

  • Communicating with others to exchange information.
  • Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

  • Remaining in a stationary position, often standing or sitting for prolonged periods.
  • Repeating motions that may include the wrists, hands, and/or fingers.
  • Must be able to provide a dedicated, secure work area.
  • Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
  • No adverse environmental conditions expected.

Base compensation ranges from $24.00 to $31.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(K) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 1/30/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 2/28/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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About the job

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Job type

Full Time

Experience level

Entry-level

Salary

Salary: 62k-65k USD

Location requirements

Hiring timezones

United States +/- 0 hours

About Cotiviti

Learn more about Cotiviti and their company culture.

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Through groundbreaking technology and profound data analytics, Cotiviti is revolutionizing the economics of healthcare. The company is at the forefront of enabling healthcare organizations to deliver enhanced care at a reduced cost, thereby ensuring the quality and sustainability of the healthcare system in the United States. Cotiviti's innovative solutions are a critical foundation for healthcare payers, empowering them in their mission to lower healthcare expenditures and elevate quality through higher-performing payment accuracy, risk adjustment, quality improvement, and consumer engagement programs. By processing and analyzing billions of clinical and financial data points, Cotiviti uncovers opportunities for clients to boost efficiency and quality, ultimately leading to better care for their members. The company's commitment to responsible AI implementation is evident in its partnership with the Responsible AI Institute, aiming to develop new ways to leverage artificial intelligence to foster a high-quality and viable healthcare system. This focus on accelerating the development of innovative healthcare technologies drives advancements in data analytics, interoperability, and value-based care solutions.

Cotiviti's expertise extends to serving the retail industry with sophisticated data management and recovery audit services designed to improve business outcomes. The company's approach is rooted in a combination of advanced technology, comprehensive data analytics, and specialized expertise. This synergy allows Cotiviti to provide solutions that address payment accuracy, quality improvement, risk adjustment, and network performance management. Cotiviti's dedication to innovation is further highlighted by its recent technological advancements, such as 360 Pattern Review, which utilizes artificial intelligence to rapidly identify potential healthcare fraud, waste, and abuse, and Zero Hour Alerts, which empowers large retailers to prevent payment errors. With a global team of over 9,000 employees, Cotiviti fosters a collaborative environment where specialized and talented teams work in tandem to ensure operational efficiency and deliver services that exceed industry standards. The company's vision is to enable a high-quality and viable healthcare system, and its mission is to improve this system through its unique blend of technology, analytics, and expertise.

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Cotiviti hiring QA I Coding Operations • Remote (Work from Home) | Himalayas