Coding Quality Assurance (QA) Manager (Risk Adjustment)

Location: Remote within the United States across all US time zones; listed locations include Durham, NC; Houston, TX; Atlanta, GA; Nashville, TN; Fort Lauderdale, FL; Phoenix, AZ; and Louisville, KY.

Company

hirify.global is a public benefit corporation supporting independent primary care organizations through value-based care models and contracts.

What you will do

• Lead, mentor, and manage a team of QA Specialists, including goal setting, productivity monitoring, and performance reviews.
• Oversee coding quality audits for internal CDI staff and external vendor partners against ICD-10-CM guidelines and risk adjustment models.
• Develop and maintain SOPs, audit workflows, scoring methodologies, and coding quality guidelines.
• Support RADV, Medicare, and commercial payer audits through chart selection, reviews, dispute documentation, and appeals.
• Evaluate vendor accuracy against SLAs and drive corrective action plans for recurring errors.
• Convert audit findings into structured feedback and targeted education for CDI specialists and vendors.

Requirements

• Bachelor’s degree in health care management, nursing, or a related field, or an associate degree with relevant CDI, coding, coding management, or HCC risk adjustment experience.
• At least 4 years of HCC coding experience, including 2 years in coding quality assurance, auditing, or compliance monitoring.
• Active AAPC and/or AHIMA credentials such as CRC, CCS, CPC, or CPMA.
• Expert knowledge of ICD-10-CM coding, CMS risk adjustment guidelines, RADV audit rules, and clinical documentation requirements.
• Leadership, communication, organizational, and vendor oversight skills.
• Experience with EHR systems and encoder software.

Nice to have

• CRC certification.
• Experience with value-based care models, ACOs, or Medicare Advantage plans.
• Experience managing small teams or leading vendor oversight programs.

Culture & Benefits

• Remote-first culture with flexible work schedules.
• Health, dental, and vision insurance paid up to 80% for employees, dependents, and domestic partners.
• 21 days of PTO in the first year, 11 paid holidays, and two paid volunteer days.
• 12 weeks of paid parental leave and a six-week paid sabbatical after six years.
• Educational assistance, clinical employee reimbursement, a 401(k) with up to 4% matching, and stock options.