Clinical Quality & Compliance Analyst

Highmark Health; Iowa City (IA); Teletrabalho; USD 63 000 - 97 000; Tempo integral

Resumo da oferta

Highmark Inc. in the Iowa City area is seeking a compliance-focused professional to work with departments across compliance, process improvement, medical record review, and coding to enhance quality of care and documentation.

The role emphasizes educating providers on CMS, NCQA standards, HEDIS, and HCC coding, conducting audits, site visits, and supporting STARS initiatives with data analyses and best practices.

Qualificações

• Current state RN or LPN licensure or Bachelor's degree in healthcare field.
• Substitutions: 6 years of experience in HEDIS/quality abstraction or HCC coding in lieu of degree.
• 3 years of nursing or healthcare-related experience.
• Medicaid/Medicare experience preferred.
• Experience with Managed Care Organizations preferred.

Responsabilidades

• Develop and manage process improvement initiatives for member and provider quality data.
• Conduct audits and reviews to improve documentation and ICD-10-CM coding.
• Monitor regulatory/accrediting requirements and adjust the compliance plan.
• Educate providers on STARS, HEDIS, and HCC coding.
• Coordinate credentialing and related activities as requested.

Conhecimentos

TQM concepts

Statistics

Verbal communication

Written communication

Data analysis

Formação académica

RN or LPN license

Bachelor's degree in healthcare

Ferramentas

Microsoft Office

Descrição da oferta de emprego

Highmark Inc. in the Iowa City area is seeking a compliance-focused professional to work with departments across compliance, process improvement, medical record review, and coding to enhance quality of care and documentation.

The role emphasizes educating providers on CMS, NCQA standards, HEDIS, and HCC coding, conducting audits, site visits, and supporting STARS initiatives with data analyses and best practices.