Certified Coder QAOI, Lead (Hybrid)- Pittsburgh, PA

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 90,000 - 120,000; Full time

Job summary

UPMC Health Plan seeks a Certified Coder Quality Assurance Operational Integrity Lead for a full-time hybrid role in Pittsburgh. You will lead QA professionals across ISD, guiding reviews to ensure operational integrity, risk mitigation, and adherence to initiatives and goals.

Candidates must hold a CPC Certification and demonstrate leadership, mentorship, and the ability to manage complex auditing projects and staff workloads.

Qualifications

• Must be a CPC certified coder with strong QA/review experience.
• Leadership and mentoring capabilities for QA staff.

Responsibilities

• Lead QA and operational integrity assessments across ISD portfolio.
• Coordinate workgroups and initiatives to drive results and efficiency.
• Provide training and guidance to staff; oversee day-to-day activities and workload distribution.
• Maintain policies and ensure compliance with departmental procedures and quality standards.

Education

CPC Certification

Certified Coder

Job description

UPMC Health Plan has an exciting opportunity for a Certified Coder Quality Assurance Operational Integrity Lead position. This is a full time position working Monday through Friday daylight hours. This is a hybrid position with flexibility.

The Certified Coder QAOI, Lead will provide front line leadership to the professionals who conduct quality assurance and operational integrity assessments and reviews across the Insurance Services Divisions’ portfolio of products, services, and functional departments, supporting ISD stakeholders and leadership to mitigate risks, ensure operational integrity, and compliance in the achievement of initiatives, business goals, and objectives. The QAOI Lead provides technical, employee and operations support to a diverse team of highly skilled quality assurance and operational integrity risk management professionals with functional expertise in clinical, financial, operational, healthcare, insurance products, IT protocols, business intelligence, and more. This position plays a crucial role in the prioritization and coordination of various team assignments and projects to help drive team results and operational efficiency.

To be considered for this position candidates must be a certified coder and have a CPC Certification.

Responsibilities:

• Serves as a positive extension of the leadership team, protects the departments’ brand and reputation, as well as 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.
• Successfully lead and/or participate on workgroups/projects/initiatives to drive results.
• Thorough understanding of the Stakeholder performance expectations, department vision, mission, objectives and aligns responsibilities accordingly.
• Demonstrate value added by capturing cost-benefit analysis.
• Responsible for the distribution of work assignments for the team, as well as workload management.
• Oversee the day-to-day activities and provides guidance/assistance, as necessary including coordination of new staff orientation.
• Serve as a process and technical expert, providing training and support as needed.
• Assume manager support and quality control as needed.
• Help professionals resolve complex challenges/issues related to their work.
• Maintain department policies, procedures, guidelines and ensures the integrity QAOI internal operations.
• Evaluate and document stakeholder needs, including current processes and proposed revisions.
• Assist with most complex QAOI projects/initiatives/reviews executing superior auditing processes, best in class risk management, or project management skills.
• Excels at generating succinct report findings and workpapers.
• Conducts quality reviews of professional staff outcomes.
• Will cover workloads as appropriate.