Clinical Quality & Coding Improvement Analyst

Highmark Health; Central City (CO); A distancia; USD 63.000 - 97.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a skilled healthcare quality professional to work across compliance, process improvement, medical record review, and coding for all product lines. You will drive process improvements, ensure accurate ICD-10-CM coding, and educate providers on documentation standards.

Responsibilities include audits, education on STARS and HEDIS, and coordinating with credentialing and quality programs to enhance care and documentation. Office-based role with travel up to 25%.

Formación

• Current state RN or LPN license or Bachelor's degree in a Healthcare-related field
• Six years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare related field in lieu of bachelor's degree
• RN or LPN licensure or equivalent multi-state license (eNLC) is required or must obtain within 4 months upon hire
• CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire

Responsabilidades

• Develop and manage process improvement initiatives with data analysis, process analysis, report generation, documentation, and HCC Coding.
• Conduct and analyze information from office/site reviews to improve care, documentation, and coding for members; coordinate with revenue, credentialing, and quality programs.
• Monitor regulatory/accrediting requirements and adjust compliance plan to CMS Coding Guidelines.
• Conduct audits (retrospective, concurrent, prospective) and continue education to providers on STARS, HEDIS, and HCC Coding; perform re-audits as needed
• Other duties as assigned or requested.

Conocimientos

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical skills

Educación

RN or LPN license

Bachelor’s degree in healthcare field

Descripción del empleo

Highmark Inc. is seeking a skilled healthcare quality professional to work across compliance, process improvement, medical record review, and coding for all product lines. You will drive process improvements, ensure accurate ICD-10-CM coding, and educate providers on documentation standards.

Responsibilities include audits, education on STARS and HEDIS, and coordinating with credentialing and quality programs to enhance care and documentation. Office-based role with travel up to 25%.