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Salary: USD 73,000 - 114,000 / annual
Devoted Health is seeking a Quality Assurance Manager to lead the QA function within the Risk Adjustment organization. This role owns the complete quality assurance program for retrospective coding and auditing operations, including policies, standard operating procedures, team management, and findings production.
You will direct a team of QA Reviewers and manage relationships with internal operational leaders and vendor partners, including offshore coding teams. Key responsibilities include:
- Serve as subject matter expert on ICD-10-CM coding guidelines, AHA Coding Clinic guidance, and internal risk adjustment protocols
- Oversee offshore QA Reviewer teams: establish accuracy and productivity standards, monitor performance, and adjust volume allocation based on results
- Own and maintain QA policies and SOPs for coding quality, retrospective coding, and audit operations
- Plan QA review coverage and sampling across internal and vendor teams to ensure representative samples and adequate review volumes
- Perform QA reviews of escalated, disputed, and high-risk charts; serve as internal authority on unresolved coding disagreements
- Own monthly and quarterly QA Scorecard processes, including accuracy verification, stakeholder delivery, and remediation follow-through
- Identify documentation and coding trends across reviewers and vendors; convert findings into education, job aids, and process improvements
- Measure QA team accuracy through individual work reviews and incorporate material findings into QA processes
- Partner with vendor leadership on quality expectations, corrective action, and escalation protocols
- Resolve coding questions from Devoted coding sources and maintain question/answer logs per policy
- Collaborate with technology and analytics teams on risk adjustment tooling, including AI-assisted coding: define QA requirements, test releases, and provide design feedback
- Build and run production monitoring for tools, tracking performance drift and error patterns
- Support retrospective coding and audits through medical record abstraction when needed
- Recommend process improvements and prepare department reporting to meet productivity and quality goals
- Serve as voting risk adjustment coding SME on Devoted's Coding Steering Workgroup
- Handle patient data in full compliance with HIPAA Privacy and Security rules
Requirements:
- Current relevant coding certification recognized by AAPC or AHIMA (CPC, CRC, CCS, CCS-P, or equivalent)
- 7+ years of recent and related experience in medical record documentation review, diagnosis coding, and/or auditing, including risk adjustment coding
- Sound knowledge of ICD-10-CM coding guidelines and regulations; ability to read medical records and abstract clinical diagnosis codes
- Experience leading development and presentation of accuracy or performance results to production coders or management
Desired qualifications:
- Expertise in CMS risk adjustment models
- Experience managing or overseeing vendor and/or offshore coding teams
- Experience validating or auditing AI-assisted, NLP, or computer-assisted coding tools
- Experience writing or substantially revising QA policies, SOPs, or audit sampling methodology
- Strong communication, organizational, and interpersonal skills
