Clinical Quality & Coding Compliance Analyst

Highmark Health; Utah; Remoto; USD 63.000 - 97.000; Tempo pieno

Descrizione del lavoro

Highmark Health seeks a quality improvement professional to manage process improvement initiatives across compliance, coding, and member/provider satisfaction. You will conduct medical record reviews, ensure ICD-10-CM coding accuracy, and support accreditation efforts.

Your role includes educating providers on STARS, HEDIS, and HCC Coding, performing audits, and coordinating with credentialing and quality improvement teams to drive continuous improvement.

Competenze

• Requires current state RN or LPN license or Bachelor’s degree in a healthcare-related field.
• Substitutions: 6 years of HEDIS/Quality abstraction, HCC Coding, or healthcare field in lieu of bachelor’s degree.

Mansioni

• Develop and manage process improvement initiatives with data analysis, process analysis, report generation, medical record documentation, and HCC Coding.
• Conduct information and data collection from site visits/reviews to improve care, documentation, and coding for members.
• Coordinate with credentialing, quality improvement, and regulatory bodies to improve STARS, value-based care, and accreditation.
• Conduct audits (retrospective, concurrent, prospective) and educate providers on STARS, HEDIS, and HCC Coding.

Conoscenze

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical/problem solving

Formazione

RN/LPN license or healthcare degree

Strumenti

Microsoft Office

Descrizione del lavoro

Highmark Health seeks a quality improvement professional to manage process improvement initiatives across compliance, coding, and member/provider satisfaction. You will conduct medical record reviews, ensure ICD-10-CM coding accuracy, and support accreditation efforts.

Your role includes educating providers on STARS, HEDIS, and HCC Coding, performing audits, and coordinating with credentialing and quality improvement teams to drive continuous improvement.