Certified Coder QAOI Lead — Hybrid, Daytime Role

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 95,000 - 125,000; Full time

Job summary

UPMC Health Plan seeks a Certified Coder Quality Assurance Operational Integrity Lead for a full-time, hybrid role (Mon–Fri, daylight hours) with flexible scheduling. The Lead will supervise QA and operational integrity reviews across ISD, guiding teams to mitigate risk and ensure compliance with initiatives and business goals. CPC certification is required.

The role emphasizes leadership, process excellence, and strong collaboration with ISD stakeholders to drive efficiency and risk management.

Qualifications

• Must be a certified coder with CPC certification.

Responsibilities

• Serves as a positive extension of the leadership team, protects the department's brand and reputation, and contributes to building a positive QAOI work community.
• Educates QAOI and ISD leadership on best-in-class risk management protocol.
• Mentors and coaches senior QAOI professional staff.
• Leads or participates in workgroups/projects to drive results.
• Understands stakeholder expectations and aligns responsibilities accordingly.
• Captures cost-benefit analysis to show value.
• Distributes work assignments and manages workload.
• Oversees day-to-day activities and coordinates new staff orientation as needed.
• Provides training and support as a process/technical expert.
• Assists with complex QAOI projects and reviews, applying auditing and risk management skills.
• Generates succinct report findings and workpapers.
• Conducts quality reviews of staff outcomes.

Skills

Certified coder

CPC Certification

Job description

UPMC Health Plan seeks a Certified Coder Quality Assurance Operational Integrity Lead for a full-time, hybrid role (Mon–Fri, daylight hours) with flexible scheduling. The Lead will supervise QA and operational integrity reviews across ISD, guiding teams to mitigate risk and ensure compliance with initiatives and business goals. CPC certification is required.

The role emphasizes leadership, process excellence, and strong collaboration with ISD stakeholders to drive efficiency and risk management.