Clinical Quality & Coding Analyst

Highmark Health; Manchester (NH); À distance; USD 63 000 - 97 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a skilled professional to advance compliance, process improvement, medical record review, and coding for all product lines in a health system setting.

The role emphasizes educating providers on documentation, CMS and NCQA standards, and continuous quality improvement. Responsibilities include audits, site visits, and education on STARS and HCC coding to support accreditation efforts.

Qualifications

• RN or LPN license or Bachelor's degree in a Healthcare-related field.
• 3 years of nursing or healthcare-related field experience.

Responsabilités

• Develop and manage process improvement initiatives for member and provider care.
• Perform data analysis and ensure proper documentation and coding.
• Monitor regulatory changes and adjust compliance plans accordingly.
• Conduct audits and provider education on STARS, HEDIS, and HCC coding.
• Coordinate credentialing and related review activities as needed.

Connaissances

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical skills

Formation

RN or LPN license

Bachelor's degree in healthcare

Outils

Microsoft Office

Description du poste

Highmark Inc. is seeking a skilled professional to advance compliance, process improvement, medical record review, and coding for all product lines in a health system setting.

The role emphasizes educating providers on documentation, CMS and NCQA standards, and continuous quality improvement. Responsibilities include audits, site visits, and education on STARS and HCC coding to support accreditation efforts.