Quality Assurance Coder/Auditor
Phoenix, AZ
Date Posted:09-Jun-2026
Work Type:On-Site
Job Number:487337
Job Description
Job Title: Quality Assurance Coder/Auditor
Location: Phoenix, AZ (Hybrid, Required to Travel into the office 1 x per week)
Duration: 6 Months (possibility of extension or conversion)
Department: Medicare/ Medicaid
Purpose of the job:
The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at-risk code identification and risk mitigation, . This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation.
The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets. Deletions will be submitted for unsupported/invalid diagnoses. This analysis combined with QA findings and EDPS claims errors will drive the content and audience for provider education.
The Quality Assurance Coder/Auditor will perform medical record reviews and abstract codes - to the highest specificity effectively from medical records based on the documentation provided. Coder/Auditor is responsible for ensuring diagnosis codes selected come from a face-to-face visit with a valid Risk Adjustable provider. Coder/Auditor will perform QA for vendors and other submitters of supplemental HCC data and provide educational feedback relevant to same.
Responsibilities:
Required Experience:
Ideal years of experience: 5+ years
Location: Phoenix, AZ (Hybrid, Required to Travel into the office 1 x per week)
Duration: 6 Months (possibility of extension or conversion)
Department: Medicare/ Medicaid
Purpose of the job:
The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at-risk code identification and risk mitigation, . This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation.
The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets. Deletions will be submitted for unsupported/invalid diagnoses. This analysis combined with QA findings and EDPS claims errors will drive the content and audience for provider education.
The Quality Assurance Coder/Auditor will perform medical record reviews and abstract codes - to the highest specificity effectively from medical records based on the documentation provided. Coder/Auditor is responsible for ensuring diagnosis codes selected come from a face-to-face visit with a valid Risk Adjustable provider. Coder/Auditor will perform QA for vendors and other submitters of supplemental HCC data and provide educational feedback relevant to same.
Responsibilities:
- Comprehensive understanding of HCC Coding rules, regulations and methodology
- Review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct coding, and recommend best coding practices and improvements
- Determine valid encounters, including face-to-face, legibility and valid signature, according to Medicare Managed Care requirements
- Track QA audits and send out monthly updates to Vendor and management team. Updates include report findings and recommendations regarding closing healthcare gaps, medical record documentation, coding, and additional educational training to management. The goal is >95% accuracy in QA audits
- Accurately and efficiently conduct medical record review/abstraction services
- Develop effective provider/coder education program in support of risk mitigation analysis.
- Travel to physician offices, conduct on-site educational training on how to close identified health care gaps, accurately document in medical record, and submit claims with correct coding. Track educational training sessions by date, provider, topic, number of attendees, etc.
- Other duties as assigned
- Maintain current knowledge of the Medicare Managed Care Manual, Chapter 7 - Risk Adjustment and Medicare outpatient billing systems/processes
- Maintain coding certification, and stay current with the numerous changes in risk adjustment methodologies
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.
Required Experience:
- 5 years of experience of professional medical coding experience, with at least 3 years of HCC coding experience. Advanced knowledge of coding guidelines coding in healthcare products.
- Certified Coding Specialist – Physician Based (CCS-P), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Outpatient Coding (COC) credential
Ideal years of experience: 5+ years
Applicant Notices & Disclaimers
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position's starting pay is: $25.00/hr.