Reveleer is a leading healthcare data and analytics company that leverages Artificial Intelligence (AI) to empower health plans in Quality Improvement, Risk Adjustment, and Member Management programs. Our innovative platform enables health plans to manage enrollment, provider outreach, data retrieval, coding, abstraction, reporting, and submissions efficiently. With cutting-edge technology and deep expertise, Reveleer ensures accurate record retrieval and review, helping health plans deliver better outcomes and greater value.
Job Description
As a Clinical Operations QA Specialist, you will ensure that clinical resources meet quality standards set by the organization. You will support the QA and Training team, monitor coding accuracy, and implement corrective actions to enhance performance.
Key Responsibilities:
✔ Conduct overread audits for coders and assist in onboarding QA processes.
✔ Provide feedback on coding errors and collaborate with trainers to improve accuracy.
✔ Assist coders with queries based on Reveleer Coding Guidelines, AHA Coding Clinics, and CMS guidelines.
✔ Perform bi-monthly quality checks, track QA scores, and ensure timely corrections.
✔ Identify outliers needing retraining and develop action plans in coordination with the training team.
✔ Analyze error trends, generate reports, and present findings to internal teams.
✔ Ensure compliance with QA policies and procedures across all clinical operations.
✔ Utilize Microsoft Office (Excel, Word, PowerPoint) and Adobe Pro for documentation and communication.
Core Competencies:
🔹 Strong analytical skills with attention to detail in clinical documentation.
🔹 Excellent communication (written & verbal) and interpersonal skills.
🔹 Professionalism – maintains confidentiality and handles pressure effectively.
🔹 Adaptability – adjusts to changing workflows and new challenges.
🔹 Tech-savvy – proficient in Microsoft Office Suite and healthcare software.
Job Requirements:
✅ AHIMA/AAPC professional coding certification (e.g., CPC, CCS, CRC).
✅ 5+ years of coding experience, specializing in Medicare/Commercial Risk Adjustment (HCC coding).
✅ Strong computer skills and reliable high-speed internet for remote work.
✅ Commitment to patient data confidentiality.
✅ Ability to work independently while collaborating with teams.
