Clinical Quality Analyst - HEDIS, HCC & Audits

Highmark Health; Muncie (IN); À distance; USD 63 000 - 97 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a compliance/quality professional in Indiana to drive process improvements, medical record review, and coding for ICD-10-CM.

You will educate providers on documentation standards and coordinate with credentialing and quality programs to improve STARS and value-based care. The role requires an RN/LPN license or healthcare degree, with certifications such as CPC/CRC/RHIA/RHIT/CCS or eligibility to obtain within 4 months.

Qualifications

• RN or LPN license or Bachelor's degree in a healthcare-related field required.
• Certified coder credentials (CPC/CRC/RHIA/RHIT/CCS) or equivalent must be obtained within 4 months of hire.
• 3 years of nursing or healthcare-related experience required.

Responsabilités

• Develop and manage process improvement initiatives including data analysis and report generation.
• Analyze medical records to assign ICD10-CM codes for chronic conditions and support STARS and value-based care.
• Educate providers on documentation and coding standards and conduct audits as needed.

Connaissances

TQM concepts

Statistics understanding

Verbal & written communication

Computer literacy

Analytical & problem solving

Formation

RN/LPN license or Bachelor's in healthcare

CPC/CRC/RHIA/RHIT/CCS certification or must obtain within 4 months

Description du poste

Highmark Inc. is seeking a compliance/quality professional in Indiana to drive process improvements, medical record review, and coding for ICD-10-CM.

You will educate providers on documentation standards and coordinate with credentialing and quality programs to improve STARS and value-based care. The role requires an RN/LPN license or healthcare degree, with certifications such as CPC/CRC/RHIA/RHIT/CCS or eligibility to obtain within 4 months.