Clinical Quality & Coding Analyst

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

Résumé du poste

Highmark Inc. in Indianapolis seeks a healthcare quality professional to support compliance, process improvement, medical record review and coding across product lines.

You will educate providers on documentation, CMS and NCQA standards, and lead audits to improve STARS, HEDIS and value-based care. The role involves data analysis, documenting findings, conducting site visits, credentialing coordination, and contributing to accreditation efforts.

Qualifications

• Experience with quality improvement concepts and coding standards.
• Ability to analyze data and ensure documentation supports ICD-10-CM coding.
• Familiarity with CMS and NCQA standards and STARS program.

Responsabilités

• Develop and manage process improvement initiatives with data analysis and reporting.
• Analyze medical records to assign ICD-10-CM codes for chronic conditions.
• Monitor CMS/Regulatory changes and update compliance plans.
• Conduct retrospective, concurrent and annual audits; identify gaps.
• Provide continuing education to providers on STARS, HEDIS, and HCC Coding.
• Perform re-audits as needed.
• Coordinate credentialing activities and other reviews as requested.

Connaissances

TQM

Statistics

Verbal comms

Written comms

MS Office

Analytical

Problem solving

Formation

RN or LPN license or Bachelor's in healthcare

6 years HEDIS/Quality abstraction or HCC coding experience

3 years nursing or healthcare-related field

Description du poste

Highmark Inc. in Indianapolis seeks a healthcare quality professional to support compliance, process improvement, medical record review and coding across product lines.

You will educate providers on documentation, CMS and NCQA standards, and lead audits to improve STARS, HEDIS and value-based care. The role involves data analysis, documenting findings, conducting site visits, credentialing coordination, and contributing to accreditation efforts.