Clinical Quality & Coding Analyst

Highmark Health; Dover; Remote; GBP 47,000 - 73,000; Full time

Job summary

Highmark Health seeks a qualified healthcare professional to lead process-improvement initiatives across departments focusing on compliant documentation and accurate ICD-10-CM coding. Responsibilities include audits, education of providers on STARS and HEDIS, and coordination with credentialing and quality programs to drive value-based care.

Required: RN/LPN license or Bachelor’s in healthcare, plus 3 years in healthcare; preferred PM experience and certification credentials such as CPC, CRC,

Qualifications

• Current state RN or LPN license or Bachelor's degree in a Healthcare-related field.
• Substitutions: 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare related field in lieu of bachelor's degree.

Responsibilities

• Develop and manage process improvement initiatives from the Organization for member and providers to include detailed data analysis, process analysis, report generation, medical record documentation, and HCC Coding.
• Conduct, collect and analyze information and data from office site and/or medical record reviews to continually improve the care, services, proper documentation and coding for members, to properly assign ICD10-CM codes to chronic conditions, and coordination with the revenue programs, credentialing and quality improvement programs to improve STARS, value-based care and achieve and maintain accreditation.
• Monitor changes, corrections and clarifications in applicable regulatory/accrediting body requirements and make adjustments to the compliance plan to follow CMS Coding Guidelines.
• Conduct retrospective, concurrent, and prospective, semi-annual, and annual audits, identify gaps and communicate results. Conduct continuing education to providers on STARS, HEDIS, and HCC Coding. Conduct re-audits as needed
• Other duties as assigned or requested.

Education

Bachelor’s degree in healthcare

Tools

Microsoft Office

Job description

Highmark Health seeks a qualified healthcare professional to lead process-improvement initiatives across departments focusing on compliant documentation and accurate ICD-10-CM coding. Responsibilities include audits, education of providers on STARS and HEDIS, and coordination with credentialing and quality programs to drive value-based care.

Required: RN/LPN license or Bachelor’s in healthcare, plus 3 years in healthcare; preferred PM experience and certification credentials such as CPC, CRC,