RAPS Consulting Inc
Direct message the job poster from RAPS Consulting Inc
Estimated start date:
ASAP (onboarding can take up to 4 weeks)
Required skills & experience:
Overview QA Lead– Computer-Assisted Coding (CAC) & Clinical Documentation Integrity (CDI)
The QA Lead for Computer-Assisted Coding (CAC) and Clinical Documentation Integrity (CDI) Software Deployment is responsible for defining, governing, and executing the quality assurance strategy for enterprise CAC/CDI implementations across inpatient, outpatient, and professional billing environments. This role ensures that system functionality, integrations, workflows, and outputs meet documented business requirements, regulatory expectations, and operational performance standards prior to and following go-live. The QA Lead partners closely with Project Management, Business Analysis, IT, Compliance, and vendors to ensure testing is requirements-driven, auditable, and aligned to long-term operational sustainability—not merely project completion.
Key Responsibilities
QA Strategy & Governance: Define and maintain the overall QA strategy and test approach for CAC/CDI implementations; develop, solicit feedback, revise, and secure approval for the comprehensive test plan.
Establish QA governance, standards, and entry/exit criteria across testing phases.
Ensure QA activities align with project schedules, risk management, and deployment milestones.
Serve as the primary escalation point for quality-related risks, defects, and readiness concerns.
Periodically audit completed testing to verify documented progress and results.
Requirements-Based Testing Leadership
Partner with Business Analysts to ensure requirements are testable, traceable, and complete.
Maintain a Requirements Traceability Matrix (RTM) linking requirements to test scenarios, test cases, defects, and outcomes.
Ensure all testing is explicitly tied to approved business, functional, and compliance requirements.
Validate that test coverage supports both project acceptance and operational use.
Test Planning & Execution Oversight
Lead planning and coordination for integrated testing, interface testing, UAT, and regression testing.
Oversee development and execution of end-to-end test scenarios, including edge cases and exception handling.
Ensure testing validates clinical, coding, CDI, and revenue cycle workflows end to end.
Clinical, Coding & Revenue Cycle Validation
Ensure validation of coding accuracy and completeness.
Validate CDI query workflows and responses.
Validate DRG/APR-DRG logic and financial impacts.
Validate downstream billing, claims, and reimbursement readiness.
Partner with Compliance to ensure regulatory and payer-aligned validation.
Confirm system behavior aligns with CMS, OIG, and AHIMA expectations.
Required Qualifications
Bachelor’s degree in Information Systems, Healthcare Administration, Health Information Management, or related field.
7+ years of healthcare QA, testing, or validation experience, including health IT implementations.
Strong working knowledge of CAC and CDI workflows; ICD-10-CM/PCS, CPT/HCPCS coding; hospital and professional revenue cycle operations in complex healthcare environments.
Experience coordinating testing across clinical, IT, and vendor teams.
Preferred Qualifications
QA, testing, or quality certifications (ISTQB, CSTE, CSQA).
HIM or revenue cycle credentials (RHIA, RHIT, CCS, CCDS, CDIP, CRC).
Experience with CAC/CDI platforms and major EHR systems.
Experience supporting regulated environments with strong audit requirements.
Seniority level: Not Applicable
Employment type: Full-time
Job function: Quality Assurance and Information Technology
Industries: IT Services and IT Consulting
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Estimated start date:
ASAP (onboarding can take up to 4 weeks)
Required skills & experience:
Overview QA Lead– Computer-Assisted Coding (CAC) & Clinical Documentation Integrity (CDI)
The QA Lead for Computer-Assisted Coding (CAC) and Clinical Documentation Integrity (CDI) Software Deployment is responsible for defining, governing, and executing the quality assurance strategy for enterprise CAC/CDI implementations across inpatient, outpatient, and professional billing environments. This role ensures that system functionality, integrations, workflows, and outputs meet documented business requirements, regulatory expectations, and operational performance standards prior to and following go-live. The QA Lead partners closely with Project Management, Business Analysis, IT, Compliance, and vendors to ensure testing is requirements-driven, auditable, and aligned to long-term operational sustainability—not merely project completion.
Key Responsibilities
QA Strategy & Governance: Define and maintain the overall QA strategy and test approach for CAC/CDI implementations; develop, solicit feedback, revise, and secure approval for the comprehensive test plan.
Establish QA governance, standards, and entry/exit criteria across testing phases.
Ensure QA activities align with project schedules, risk management, and deployment milestones.
Serve as the primary escalation point for quality-related risks, defects, and readiness concerns.
Periodically audit completed testing to verify documented progress and results.
Requirements-Based Testing Leadership
Partner with Business Analysts to ensure requirements are testable, traceable, and complete.
Maintain a Requirements Traceability Matrix (RTM) linking requirements to test scenarios, test cases, defects, and outcomes.
Ensure all testing is explicitly tied to approved business, functional, and compliance requirements.
Validate that test coverage supports both project acceptance and operational use.
Test Planning & Execution Oversight
Lead planning and coordination for integrated testing, interface testing, UAT, and regression testing.
Oversee development and execution of end-to-end test scenarios, including edge cases and exception handling.
Ensure testing validates clinical, coding, CDI, and revenue cycle workflows end to end.
Clinical, Coding & Revenue Cycle Validation
Ensure validation of coding accuracy and completeness.
Validate CDI query workflows and responses.
Validate DRG/APR-DRG logic and financial impacts.
Validate downstream billing, claims, and reimbursement readiness.
Partner with Compliance to ensure regulatory and payer-aligned validation.
Confirm system behavior aligns with CMS, OIG, and AHIMA expectations.
Required Qualifications
Bachelor’s degree in Information Systems, Healthcare Administration, Health Information Management, or related field.
7+ years of healthcare QA, testing, or validation experience, including health IT implementations.
Strong working knowledge of CAC and CDI workflows; ICD-10-CM/PCS, CPT/HCPCS coding; hospital and professional revenue cycle operations in complex healthcare environments.
Experience coordinating testing across clinical, IT, and vendor teams.
Preferred Qualifications
QA, testing, or quality certifications (ISTQB, CSTE, CSQA).
HIM or revenue cycle credentials (RHIA, RHIT, CCS, CCDS, CDIP, CRC).
Experience with CAC/CDI platforms and major EHR systems.
Experience supporting regulated environments with strong audit requirements.
Seniority level: Not Applicable
Employment type: Full-time
Job function: Quality Assurance and Information Technology
Industries: IT Services and IT Consulting
#J-18808-Ljbffr