Clinical Quality & Compliance Analyst

Highmark Health; Little Rock (AR); Remote; USD 63.000 - 97.000; Vollzeit

Zusammenfassung

Highmark Inc. in Little Rock, AR seeks a clinical quality professional to collaborate across compliance, process improvement, medical record review, and coding for all product lines.

You will propose and implement improvements for high-quality care and accurate ICD-10-CM coding, while educating staff on documentation standards. The role includes audits, provider education on STARS/HEDIS/HCC Coding, credentialing coordination, and adherence to CMS/NCQA standards.

Qualifikationen

• Current RN or LPN license or healthcare-related Bachelor's.
• 3 years of nursing or healthcare-related experience.
• CPC/CRC/RHIA/RHIT/CCS certification or eligible within 4 months of hire.
• Experience with HEDIS/Quality abstraction and coding preferred.

Aufgaben

• Develop and manage process improvement initiatives with data analysis, process analysis, report generation and HCC coding.
• Conduct medical record reviews to improve documentation and coding for members.
• Monitor regulatory/accreditation requirements and adjust the compliance plan to CMS guidelines.
• Perform audits and communicate results; coordinate credentialing activities as requested.
• Provide continuing education to providers on STARS, HEDIS and HCC Coding.
• Conduct re-audits as needed.

Kenntnisse

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical thinking

Problem-solving

Ausbildung

RN or LPN license or healthcare Bachelor's

CPC/CRC/RHIA/RHIT/CCS certification or eligible

Tools

Microsoft Office Suite

Jobbeschreibung

Highmark Inc. in Little Rock, AR seeks a clinical quality professional to collaborate across compliance, process improvement, medical record review, and coding for all product lines.

You will propose and implement improvements for high-quality care and accurate ICD-10-CM coding, while educating staff on documentation standards. The role includes audits, provider education on STARS/HEDIS/HCC Coding, credentialing coordination, and adherence to CMS/NCQA standards.