QA Educator Supervisor - Medical Coding Academy

Job Purpose

The Academe Inpatient Medical Coding QA Educator Supervisor oversees the daily operations of the QA team responsible for auditing inpatient coding accuracy and compliance. This role ensures adherence to ICD-10-CM/PCS guidelines, UHDDS standards, and payer-specific requirements. The QA Supervisor drives quality performance through audit planning, error analysis, rebuttal management, and team development, while collaborating with Operations and Training to maintain coding integrity and reduce financial risk.

Key Responsibilities

QA Operations Management

• Supervise QA auditors assigned to inpatient accounts; monitor productivity, accuracy, and timeliness of audits.
• Allocate audit samples based on client requirements, risk areas, and internal sampling strategies (e.g., 10% audit coverage).
• Ensure consistent application of audit hierarchy, error taxonomy, and POA indicators across all reviews.
• Validate audit findings for accuracy and compliance; resolve discrepancies.
  
  

• Track and report QA metrics (accuracy scores, error trends, DRG shifts, denial patterns) through dashboards and scorecards.
• Conduct root cause analysis on recurring errors and collaborate with QA Educator for targeted remediation plans.
• Prepare weekly/monthly QA performance reports for leadership and client-facing reviews.
  
  

• Review coder rebuttals objectively; ensure decisions are evidence-based and aligned with official guidelines.
• Document RCA for critical errors and escalate systemic issues to leadership for process improvement.
  
  

• Maintain up-to-date knowledge of ICD-10-CM/PCS Official Guidelines, CMS MS-DRG logic, UHDDS definitions, and Coding Clinic updates.
• Ensure QA processes comply with HIPAA-equivalent privacy and organizational security standards.
  
  

• Coach and mentor QA auditors; conduct performance evaluations and competency assessments.
• Identify training needs and coordinate with QA Educator for skill enhancement programs.
• Foster a culture of accountability, collaboration, and continuous improvement.
  
  

• Partner with Operations Supervisor/Manager and Training team to align glidepaths, audit timelines, and coder remediation plans.
• Participate in client calls to discuss QA outcomes, sampling strategies, and compliance initiatives.
  
  

• Education: Bachelor’s degree in health information management, Nursing, or related field.
• Certifications: Must have CCS/CIC certification. Preferably with either CPMA/Six Sigma Certification – green or black belt.
• Experience:
• Solid 5 years inpatient DRG QA and/or training experience (ICD-10-CM/PCS, MS-DRG).
• Strong understanding of DRG validation, POA reporting, and UHDDS standards.
  

• Technical Expertise: ICD-10-CM/PCS coding, DRG grouping, audit hierarchy, POA assignment.
• Analytical Skills: Trend analysis, RCA, KPI tracking.
• Leadership: Team supervision, coaching, performance management.
• Communication: Clear and professional verbal/written communication; ability to present QA findings to stakeholders.
• Tools: Encoder/groupers, EHR systems, QA dashboards (Excel/Sheets), reporting tools.
  
  

• QA audit accuracy.
• Timely completion of audit sampling per SLA.
• Reduction in error recurrence and DRG shifts.
• Effective rebuttal resolution within defined timelines.
• Team engagement and competency improvement.
  
  

• Schedule: Standard business hours with flexibility for cross-geo collaboration.
• Work Mode: Hybrid
• Data Security: Strict adherence to HIPAA-equivalent privacy and organizational confidentiality policies.