Lead Certified Coder QAOI- Remote

UPMC; Pittsburgh (Allegheny County); Remote; USD 95,000 - 130,000; Full time

Job summary

UPMC Health Plan seeks a Lead Certified Coder Quality Assurance Operational Integrity to guide QA and operational integrity across ISD products and services. This remote, full-time role focuses on mitigating risks, ensuring compliance, and driving efficiency through expert leadership and strategic QA initiatives.

Qualified candidates hold CPC certification and will mentor staff, coordinate projects, and educate leadership on best practices in risk management and auditing within healthcare and

Qualifications

• Certified coder with CPC certification required.
• Experience leading QA teams in healthcare quality/operational integrity.
• Strong knowledge of risk management in healthcare/insurance.

Responsibilities

• Lead QA and ISD QA team activities to drive results and efficiency.
• Educate leadership on risk management best practices and QA processes.
• Coach and mentor senior QA staff and oversee staff onboarding.

Skills

Leadership

Mentoring

Risk management

Training

Project management

Stakeholder engagement

Communication

Education

CPC Certification

Tools

Quality auditing tools

Job description

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

The Lead Certified Coder QAOI 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.