Quality Assurance I, Clinical Ops – Risk Coding at Cotiviti


QA I, Clinical Ops (Risk Coding)

  • Job Category: Coding
  • Requisition Number: QAICL05181
  • Nationwide (Remote)

Job Details


The QA I, Clinical Ops position works with the Coding & Clinical Validation Audit team focused on risk coding. The QA position monitors & reports on the accuracy of all code captures on a % of all images of their assigned coders. This position also answers all questions for their coders through the Questions Queue or via email. QA is also responsible for assisting in the remediation for their coders which include full image review of all images coded prior to release to ensure accuracy of image, for any coder below project benchmark.

Primary Responsibilities:

  • Provides Quality Assurance feedback by working as a liaison between Coder I, Coder II and the Team Lead to ensure 95% coding accuracy. Reviews a defined percentage of the Coder I and Coder II work to ensure a 95% accuracy rate is maintained. This is for new hires as well as existing staff.
    • 100% of the work is reviewed for a new Hire until they have a consistent 95% accuracy rate
    • No more than 10% of the work is reviewed for Coder I, Coder II once they have tested at 95% quality.
  • Completes image review for proper HCC mapped diagnosis coding from various chart types (physician, Facility, non – Facility). Ensures that the highest level of HCC mapped diagnosis code was utilized in each date of service reviewed and documentation of findings in company data storage program. Professionally communicates finds, errors, and any suggestions to all staff in order to facilitate on-going communications and efficient department operations.
  • Completes internal audits as necessary to support quality accuracy.
  • Responds to questions via the ‘Questions Queue’ for individual coders.
  • Reviews internal system reports on quality of work for all assigned Clinical Coder Specialists. These reports are reviewed daily, weekly, monthly, quarterly and yearly as needed.
  • Communicate quality issues and trends to the Team lead, Coding Manager and Training Manager.
  • Recommend additional training based on results of the quality audit for those Coder I and Coder II where they fall behind the 95% accuracy rate.
  • Develop an action plan in collaboration with the Team Lead and Manager as needed with regard to improvement in the quality of work for a Coder I or II and reports progress to the Team Lead.
  • Regular interaction with other Cotiviti staff, such as training and quality assurance to facilitate clarification and/or training on coding results.
  • May have occasional special projects that will entail a full coding review.
  • Professionally communicates finds, errors, and any suggestions to Team Lead to facilitate on-going communications and efficient department operations as part of a continuous improvement process..
  • Utilize Cotiviti training tools and coding library for questions.
  • Completes all responsibilities as outlined on annual Performance Plan.
  • Completes all special projects and other duties as assigned.
  • Must be able to perform duties with or without reasonable accommodation.


  • High School diploma required, Bachelor’s degree preferred.
  • Clinical background preferred, but not required.
  • Coding certification required through AAPC or AHIMA (CPC, CRC, CCS, etc.).
  • Expertise in medical record auditing, particularly in HCC mapped diagnosis coding.
  • Minimum of one to three years HCC coding experience.
  • Demonstrated greater than 95% accuracy in HCC coding work.
  • Adherence to official coding guidelines, coding clinic determinations, client specific coding guidelines, CMS and other regulatory compliance guidelines and mandates.
  • Ability to read and understand medical record documentation.
  • Must be able to identify trends in coding and documentation errors, to include over and under-coding.
  • Excellent written and verbal skills to include coaching and interpersonal skills.
  • Strong knowledge of medical terminology and anatomy and physiology.
  • Skilled in organization and customer service.
  • Computer and technology literate.
  • Analytical and problem solving skills.
  • Ability to manage and meet deadlines.
  • Must remain flexible to provide assistance in any emergent situations and/or projects.
  • Must participate in any required training..
  • Must abide by all HIPAA and associated patient confidentiality requirements.

For the safety of our employees and those considering employment with Cotiviti, we are currently conducting all interviews virtually. In addition, the majority of the Cotiviti team is currently working remotely, and we are onboarding new hires remotely as well. As we monitor the pandemic, these arrangements may change and we will update accordingly.



Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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