Remote Lead Certified Coder & QA Expert

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 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.