Coding Quality Assurance (QA) Manager, Remote

Aledade
Durham, Houston, Atlanta, Nashville, Florida, Phoenix, Louisville
Workplace: RemoteFull timeFunction: QA, Test & Release EngineeringExperience: 4+ yearsEducation: bachelorsSkills: ["Leadership","Communication","Organizational skills"]

Lead a team of QA Specialists focused on coding accuracy and audit readiness across internal CDI staff and external vendor partners. Oversee quality assurance reviews tied to ICD-10-CM, CMS Risk Adjustment, and RADV requirements, and build/maintain SOPs, audit workflows, and scoring methodologies. Serve as a subject matter expert during external payer audits, manage vendor performance against SLAs, and turn findings into targeted education and corrective actions.

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Aledade
Aledade
4 days ago

Coding Quality Assurance (QA) Manager, Remote

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Last checked: 14 hours agoStatus: Live

Job Summary

Lead a team of QA Specialists focused on coding accuracy and audit readiness across internal CDI staff and external vendor partners. Oversee quality assurance reviews tied to ICD-10-CM, CMS Risk Adjustment, and RADV requirements, and build/maintain SOPs, audit workflows, and scoring methodologies. Serve as a subject matter expert during external payer audits, manage vendor performance against SLAs, and turn findings into targeted education and corrective actions.
Location: Durham, Houston, Atlanta, Nashville, Florida, Phoenix, Louisville
Workplace: Remote
Employment Type: Full time
Job Function: QA, Test & Release Engineering
Seniority: Manager level

Key Responsibilities

  • •Lead, mentor, and manage a team of QA Specialists, including goal setting, productivity monitoring, performance reviews, and continuous learning.
  • •Oversee coding quality assurance reviews for internal CDI staff and external vendor partners to ensure compliance with ICD-10-CM guidelines and risk adjustment models.
  • •Design and maintain SOPs, audit workflows, scoring methodologies, and coding quality guidelines across the organization.
  • •Act as a subject matter expert during external payer audits (e.g., RADV, Medicare, Commercial), supporting chart selection, disputes, and appeal responses.
  • •Evaluate vendor accuracy against SLA targets and translate audit findings into actionable insights, structured feedback, and education to prevent recurring errors.

Pay and Benefits

Perks:Health InsuranceDentalVision401kEquityPaid LeaveParental LeaveLearning Budget

Key Requirements

  • •Bachelor’s degree in health care management, nursing, or a related field, or an Associate Degree with relevant CDI/coding/coding management/HCC Risk Adjustment experience.
  • •Minimum of 4 years of HCC coding experience, including 2 years focused on coding quality assurance, auditing, or compliance monitoring.
  • •Active professional credentials from AAPC and/or AHIMA (e.g., CRC, CCS, CPC, CPMA).
  • •Deep mastery of ICD-10-CM coding, CMS Risk Adjustment guidelines, RADV audit rules, and clinical documentation requirements.
  • •Experience working within value-based care (VBC) models such as ACOs or Advantage plans.
Experience:4+ yearsValue-based careRisk adjustmentHCC codingCoding complianceAudit readiness
Education:Bachelor's
Skills:LeadershipCommunicationOrganizational skills
Certifications:CRCCCSCPCCPMA
Tech Stack:ICD-10-CMCMS Risk AdjustmentRADVEHR systemsEncoder softwareHCCClinical documentation requirements

Company Brief

Aledade
Provides technology, services, and care-management support to independent primary care practices to participate in value-based care and accountable care organizations, helping clinicians improve outcomes, reduce costs, and share in savings.
Industry: HealthTech
Company Size: Large (251 to 1,000 employees)
Growth: Scaleup
Headquarters: Bethesda, United States
Founded: 2014
WebsiteLinkedIn