Overview
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 both pre- and post-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 with long-term operational sustainability.
Key Responsibilities
- QA Strategy & Governance
- Define and maintain the overall QA strategy and test approach for CAC/CDI implementations
- Develop, review, and finalize comprehensive test plans
- Establish QA governance, standards, and entry/exit criteria across testing phases
- Align QA activities with project timelines, risk management, and deployment milestones
- Act as the primary escalation point for quality risks, defects, and readiness concerns
- Conduct periodic audits of testing progress and results
- Requirements-Based Testing Leadership
- Partner with Business Analysts to ensure requirements are testable and complete
- Maintain a Requirements Traceability Matrix (RTM) linking Requirements, Test cases, Defects, Outcomes
- Ensure all testing aligns with approved business, functional, and compliance requirements
- Validate that test coverage supports both project acceptance and operational readiness
- Test Planning & Execution Oversight
- Lead and coordinate: Unit Testing (Vendor/IT), Integration Testing, Interface Testing, User Acceptance Testing (UAT), Regression Testing
- Oversee development of end-to-end test scenarios, including edge cases and exception handling
- Ensure validation across clinical, coding, CDI, and revenue cycle workflows
- Clinical, Coding & Revenue Cycle Validation
- Validate:
- Coding accuracy and completeness
- CDI workflows (queries and responses)
- DRG/APR-DRG logic and financial impact
- Downstream billing, claims, and reimbursement readiness
- Collaborate with Compliance to ensure regulatory and payer alignment
- Ensure adherence to standards from CMS, OIG, and AHIMA
Required Qualifications
- Bachelor s degree in: Information Systems, Healthcare Administration, Health Information Management Or related field
- 8+ years of experience in healthcare QA, testing, or validation
- Strong knowledge of:
- CAC and CDI workflows
- ICD-10-CM/PCS, CPT, HCPCS coding
- Hospital and professional revenue cycle operations
- Experience coordinating testing across clinical, IT, and vendor teams
Preferred Qualifications
- QA certifications (ISTQB, CSTE, CSQA)
- HIM or revenue cycle certifications:
- RHIA, RHIT, CCS, CCDS, CDIP, CRC
- Hands-on experience with CAC/CDI platforms (e.g., 3M, Optum, Nuance)
- Experience with major EHR systems (Epic, Cerner, Meditech)
- Experience in regulated environments with strong audit and compliance requirements
Key Skills & Competencies
- QA Leadership & Governance
- Healthcare Domain Expertise
- Revenue Cycle Knowledge
- Requirements Traceability & Documentation
- Stakeholder Management
- Risk & Compliance Awareness
- Analytical & Problem-Solving Skills
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