Lead Certified Coder QA & Risk Manager (Hybrid)

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 100,000 - 140,000; Full time

Job summary

UPMC Health Plan is seeking a Certified Coder Quality Assurance Operational Integrity Lead for a full-time hybrid role with daylight hours, Monday–Friday. Leads QA/operational integrity reviews across ISD products and departments, guiding teams to mitigate risk and ensure regulatory compliance.

The role requires CPC certification, a bachelor’s degree or equivalent experience, and strong leadership in healthcare QA, IT, and data-driven risk management.

Qualifications

• Bachelor's degree or equivalent professional experience in a relevant field.
• CPC Certification is required for consideration.
• CIA certification preferred and healthcare knowledge is highly valued.
• 7+ years of related experience in quality assurance, operational controls, risk management, auditing, or customer service.

Responsibilities

• Serves as a positive extension of the leadership team, protects the department's brand and reputation, and contributes to a positive QAOI work community.
• Educates QAOI and ISD leadership on best-in-class risk management protocol.
• Mentors and coaches senior QAOI professionals.
• Lead and/or participate on workgroups/projects/initiatives to drive results.
• Understand stakeholder expectations and align responsibilities with the department vision and objectives.
• Demonstrate value added by capturing cost-benefit analysis.
• Distribute work assignments and manage team workload.
• Oversee day-to-day activities and coordinate new staff orientation.
• Provide training and support as needed and act as process and technical expert.
• Assume manager support and quality control as needed.
• Help professionals resolve complex challenges related to their work.
• Maintain department policies, procedures, guidelines and ensure operational integrity.
• Evaluate and document stakeholder needs and proposed revisions.
• Assist with complex QAOI projects ensuring superior auditing processes and risk management.
• Generate succinct report findings and workpapers; conduct quality reviews of staff outcomes.

Skills

Leadership

Quality assurance

Risk management

Project management

Communication

Education

Bachelor's degree or equivalent professional experience

CIA certification preferred

Tools

MS Teams

Word

Excel

Visio

Job description

UPMC Health Plan is seeking a Certified Coder Quality Assurance Operational Integrity Lead for a full-time hybrid role with daylight hours, Monday–Friday. Leads QA/operational integrity reviews across ISD products and departments, guiding teams to mitigate risk and ensure regulatory compliance.

The role requires CPC certification, a bachelor’s degree or equivalent experience, and strong leadership in healthcare QA, IT, and data-driven risk management.