Lead Certified Coder QAOI- Remote

UPMC; United States; Remote; USD 120,000 - 160,000; Full time

Job summary

UPMC Health Plan seeks a Lead Certified Coder Quality Assurance Operational Integrity professional to lead QA and operational integrity reviews across ISD. This remote, full-time role requires CPC certification and strong leadership to drive risk management and compliance initiatives.

The candidate will mentor staff, coordinate workgroups, and ensure high-quality audit processes while supporting ISD stakeholders nationwide. Excellent communication and project management are essential.

Qualifications

• Bachelors degree or equivalent professional experience with 7 years in quality assurance, risk management, auditing, or related.
• CIA certification preferred.
• 1 year experience leading or facilitating meetings.
• 1 year experience coaching and mentoring.
• Strong knowledge of healthcare portfolio of products, services, and/or functional departments or experience auditing in a regulated industry.

Responsibilities

• Acts as a leadership extension, protecting department brand and guiding QAOI team.
• Educates ISD leadership on risk management best practices.
• Mentors and coaches Senior QAOI staff.
• Leads or participates in workgroups to drive results.
• Understands stakeholder expectations and aligns team responsibilities.
• Documented cost-benefit analysis and value delivery.
• Manages team workloads and assigns tasks.
• Oversees day-to-day activities and on-boards new staff.
• Provides training and technical guidance as needed.
• Supports managers and ensures quality control as needed.
• Resolves complex challenges in QAOI projects.
• Maintains QAOI policies and procedures.
• Evaluates stakeholder needs and current processes.
• Executes complex audits and risk management practices.
• Generates clear report findings and workpapers.
• Conducts quality reviews of outcomes.
• Covers workloads as needed.

Skills

Leadership

Mentoring

Project management

Analytical skills

Stakeholder management

Communication skills

Healthcare knowledge

Education

Bachelor's degree or equivalent

CIA certification preferred

Tools

MS Teams

Microsoft Word

Microsoft Excel

Visio

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.

• Bachelors degree or equivalent professional experience, along with 7 years of related experience in quality assurance, operational controls, risk management, auditing, or customer service.

• CIA certification preferred.

• 1 year experience leading or facilitating meetings.

• 1 year experience coaching and mentoring. Strong knowledge of a healthcare portfolio of products, services, and/or functional departments or experience auditing in a heavily regulated industry required.

• Healthcare specialization in any of the following disciplines strongly preferred:

• Clinical, claim financial ties, HCC diagnosis coding, quality data science, IT process controls, IT SDLC or advanced project management.

• Ability to comprehend and apply relevant information to tasks and assignments.

• Detailed oriented with advanced critical thinking skills, advanced analytical skills, and advanced project management skills.

• Excellent oral, written, and reporting communication skills.

• Must possess a professional demeanor with the ability to manage multiple priorities and meet deadlines required.

• Proficiency using MS Teams, Word, and Excel.

• Ability to learn Visio and auditing technology.

• Ability to apply data extraction and leverage data extraction tools.Licensure, Certifications, and Clearances:CIA, Six Sigma, PM, or SAFe preferred. UPMC is an Equal Opportunity Employer/Disability/Veteran