Clinical Quality & Compliance Analyst (HEDIS/HCC Coding)

Highmark Health; New Hampshire; Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health in New Hampshire seeks a quality and compliance professional to partner with compliance, process improvement, medical record review and coding teams to enhance documentation and ICD-10-CM coding across all product lines.

You will lead process improvement initiatives, conduct audits, educate providers on STARS, HEDIS and HCC coding, and coordinate credentialing activities and site visits to drive improved member and provider satisfaction.

Qualifications

• 3 years of nursing or healthcare-related field
• RN or LPN license or healthcare bachelor's
• CPC/CRC/RHIA/RHIT/CCS or eligible within 4 months

Responsibilities

• Develop and manage process improvement initiatives with data analysis, reporting and coding
• Conduct medical record reviews to improve documentation and ICD-10-CM coding
• Educate providers on STARS, HEDIS and HCC coding
• Coordinate credentialing, audits and site visits
• Support regulatory compliance and quality improvement efforts

Skills

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Data analysis

Problem solving

Clinical data interpretation

Education

RN or LPN license or healthcare bachelor's

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

Tools

None

Job description

Highmark Health in New Hampshire seeks a quality and compliance professional to partner with compliance, process improvement, medical record review and coding teams to enhance documentation and ICD-10-CM coding across all product lines.

You will lead process improvement initiatives, conduct audits, educate providers on STARS, HEDIS and HCC coding, and coordinate credentialing activities and site visits to drive improved member and provider satisfaction.