Quality Assurance Manager (Healthcare)

Location: Remote USA

Salary: $73,000–$114,000 per year

Company

hirify.global builds an integrated care platform combining clinical and service experiences with data and AI to improve the health and well-being of older Americans.

What you will do

• Own the quality assurance program for retrospective coding, auditing operations, related policies, SOPs, sampling, and coverage planning.
• Direct QA Reviewers and oversee vendor QA performance, including accuracy, productivity, staffing, training, corrective action, and escalations.
• Review escalated, disputed, and high-risk charts, resolve coding disagreements, and verify that diagnoses are supported by clinical documentation.
• Own monthly and quarterly QA scorecards, present findings to leadership, coders, and vendor partners, and track remediation plans.
• Identify coding and documentation trends and convert findings into education, job aids, reporting, and process improvements.
• Partner with technology and analytics teams on risk adjustment tooling, including AI-assisted coding, release testing, production monitoring, and error analysis.

Requirements

• Current relevant AAPC or AHIMA certification, such as CPC, CRC, CCS, or CCS-P.
• 7+ years of recent experience in medical record documentation review, diagnosis coding, auditing, and/or risk adjustment coding.
• Experience developing and presenting accuracy or performance results to production coders or management.
• Strong knowledge of ICD-10-CM coding guidelines, AHA Coding Clinic guidance, regulations, compliance requirements, and medical record abstraction.
• Ability to handle patient data in accordance with HIPAA Privacy and Security rules and applicable internal policies.

Nice to have

• Expertise in CMS risk adjustment models.
• Experience managing or overseeing vendor or offshore coding teams.
• Experience validating or auditing AI-assisted, NLP, computer-assisted coding, or automated chart review tools.
• Experience writing or substantially revising QA policies, SOPs, or audit sampling methodologies.
• Strong communication, organizational, and interpersonal skills for presenting QA results and delivering findings.

Culture & Benefits

• Full-time employment with employer-sponsored health, dental, and vision plans.
• Generous paid time off and a parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options for all employees and bonus eligibility for most roles.
• 401(k) program and a collaborative, supportive work environment.