Clinical Quality & Coding Improvement Analyst

Highmark Health; Colorado Springs (CO); A distancia; USD 63.000 - 97.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a compliance and quality improvement professional to work with departments on improving documentation, coding, and member/provider satisfaction across product lines.

The role focuses on HMIS/HCC coding, STARS, and CMS/NCQA standards, with audits and education for providers to ensure timely, accurate data and continuous quality improvement. The position requires nursing or healthcare experience (RN/LPN or higher), knowledge of CMS guidelines, and the ability to coordinate

Formación

• RN or LPN license or Bachelor’s degree in a healthcare-related field.
• Substitutions: 6 years of experience with HEDIS/Quality abstraction, HCC Coding, or healthcare-related field in lieu of bachelor’s degree.
• EXPERIENCE: 3 years of nursing or healthcare-related field; Project management preferred; Medicaid/Medicare experience.

Responsabilidades

• Develop and manage process improvement initiatives with data analysis, reporting, documentation, and HCC coding.
• Conduct data collection and analysis from site visits and records to improve care, documentation, and coding for members.
• Monitor regulatory/accrediting changes and adjust the compliance plan to CMS Coding Guidelines.
• Perform retrospective, concurrent, and prospective audits; identify gaps and report results.
• Provide continuing education to providers on STARS, HEDIS, and HCC Coding.
• Perform re-audits as needed and support other duties as assigned.

Conocimientos

TQM concepts

Statistics

Verbal communication

Written communication

Problem resolution

Computer literacy

MS Office

Analytical skills

Educación

RN or LPN license or Bachelor's degree in healthcare

6 years of healthcare quality/HEDIS coding experience

Herramientas

MS Office

Descripción del empleo

Highmark Inc. is seeking a compliance and quality improvement professional to work with departments on improving documentation, coding, and member/provider satisfaction across product lines.

The role focuses on HMIS/HCC coding, STARS, and CMS/NCQA standards, with audits and education for providers to ensure timely, accurate data and continuous quality improvement. The position requires nursing or healthcare experience (RN/LPN or higher), knowledge of CMS guidelines, and the ability to coordinate