Clinical Quality & Compliance Analyst

Highmark Health; Wyoming (MI); À distance; USD 63 000 - 97 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a qualified professional to advance quality improvement across multiple product lines. The role focuses on documentation, coding accuracy (ICD-10-CM), and provider education to enhance STAR ratings and value-based care.

You will coordinate audits, engage with regulatory standards, and support credentialing activities. You will train staff on coding guidelines, analyze data, and drive process improvements.

Qualifications

• Current state RN or LPN license or Bachelor's degree in a Healthcare-related field.
• Experience with HEDIS/Quality abstraction, HCC coding, or healthcare field in lieu of degree.
• CPC, CRC, RHIA, RHIT, or CCS certification or must obtain within 4 months on hire.

Responsabilités

• Develop and manage process improvement initiatives with data analysis and reporting.
• Analyze information from reviews to improve care, documentation, and coding.
• Monitor regulatory/accrediting requirements and adjust the compliance plan accordingly.
• Conduct audits (retrospective, concurrent, prospective) and communicate results.
• Provide continuing education to providers on STARS, HEDIS, and HCC Coding.
• Perform re-audits as needed and other duties as assigned.

Connaissances

Total Quality Management

Statistics

Verbal communication

Written communication

Microsoft Office

Analytical skills

Formation

RN or LPN license or Bachelor's in Healthcare

CPC / CRC / RHIA / RHIT / CCS certification (within 4 months)

Outils

Medical coding software

CMS Coding Guidelines

Description du poste

Highmark Inc. is seeking a qualified professional to advance quality improvement across multiple product lines. The role focuses on documentation, coding accuracy (ICD-10-CM), and provider education to enhance STAR ratings and value-based care.

You will coordinate audits, engage with regulatory standards, and support credentialing activities. You will train staff on coding guidelines, analyze data, and drive process improvements.