Opportunities in the Upfront Portfolio


Clinical Operations QA Specialist



Operations, Quality Assurance
United States
Posted on Friday, March 1, 2024

Clinical Operations QA Specialist

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.

As a Clinical QA Specialist, you will be responsible for ensuring all clinical resources are monitored to meet quality scores based on QA standards set by the organization. Your responsibilities also include providing support to clinical QA and Training team to deliver excellent quality and productivity outcome.

The ideal candidate is detail-oriented, able to work independently and at the same time able to collaborate with team members and staff. Ideal candidate will demonstrate initiative and leadership in designing new QA protocols and QA policies in the bounds of Reveleer clinical operations and serves as subject matter expert and support to staff at all levels throughout the organization..

Essential Functions:

  • Completes overread of chases for coders in production and provides support in completing initial QA process during onboarding.
  • Communicates with and provides feedback to the Training and QA team of coding error trends and assist in creating action plans to mitigate QA discrepancies.
  • Assists coders in resolving coding queries based on Reveleer Coding Guidelines, AHA Coding Clinics, CMS Coders Guidance on Medical Review.
  • Create and maintain quality control activities: Bi-monthly quality check on performance, monthly quality assurance reviews, keeping track of QA scores and make sure that all corrections are done in a timely manner.
  • During the bi-monthly quality checks – able to identify outliers that needs retraining and set action plans and communicated either on one-on-one or group teaching in coordination with the training team.
  • Pulls reports to better understand error trends and present to internal team for deliberation.
  • Collaborate and consult effectively with all levels of the QA teams to ensure adherence to policies and procedures.
  • Well-versed and Knowledgeable on Microsoft Office applications (Excel, Word, Powerpoint) as well as Adobe Pro and use these applications to handle communication within the clinical team.
  • Additional duties as necessary to meet our obligations to our customers.

Core Competencies:

  • Caring – Warm, sincere, calm, cool and collected energy and presence with the ability to develop relationships.
  • Analytical Skills and Attention to Detail– Reviewing clinical documentation and coding.
  • Effectively Communicates – Speaks clearly, listens effectively, and responds well to questions; Writes clearly and informatively; Edits work for errors; Varies writing style to meet needs; Able to read and interpret information; Documents are accurate and delivered on time; Uses good judgement when communicating information.
  • Interpersonal Skills - Builds strong relationships; Flexible and open minded; Receptive to feedback; Motivates employees and peers for the purpose of achieving organizational goals.
  • Professionalism – Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
  • Adaptability – Adapts to changes in the work environment; Adjusts methods to best fit the situation; Able to deal with change, delays, or unexpected events. Can work with diverse groups of customers and internal stakeholders.
  • Cultural Sensitivity – Models behaviors that reflect the culture of Reveleer; Awareness of the similarities and differences that exist between employees, teams, departments, and customers to build more effective relationships.
  • Computer Skills – Essential to be skilled in with all Microsoft Suite products (e.g., Excel, Word, PowerPoint, etc.)

Job Requirements:

  • Must have a professional coding certificate through AHIMA/AAPC
  • Minimum of 5 years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC)
  • Strong computer skills and high-speed internet access at home
  • Commitment to confidentiality of patient health information
  • Professional, articulate and able to work independently

Compensation: $32.25 / hour

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.

Reveleer E-Verifies all new hires.

Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.