Clinical Quality Improvement & Coding Analyst

Highmark Health; Lexington (KY); À distance; USD 63 000 - 97 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a compliance/quality professional to work with departments across the organization. The role focuses on improving documentation and coding for ICD-10-CM, conducting audits, and educating providers on STARS, HEDIS, and HCC coding.

The position requires an RN/LPN license or healthcare degree, and applicable coding certifications. Candidates should have 3+ years in nursing or healthcare and 4 months to obtain certain certifications. Office-based with potential travel.

Qualifications

• Current state RN or LPN license or Bachelor’s degree in a healthcare-related field.
• 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare-related field in lieu of bachelor’s degree.
• 3 years of nursing or healthcare-related field.
• CPC, CRC, RHIA, RHIT, or CCS certification or must obtain within 4 months upon hire.

Responsabilités

• Develop and manage process improvement initiatives with data analysis, process analysis, and report generation.
• Conduct information and data collection from office site and/or medical record reviews to improve care and documentation.
• Monitor regulatory/accrediting requirements and adjust the compliance plan to CMS Coding Guidelines.
• Conduct retrospective, concurrent, and prospective audits; identify gaps and communicate results.
• Provide continuing education to providers on STARS, HEDIS, and HCC Coding.
• Perform re-audits as needed.
• Other duties as assigned.

Connaissances

TQM concepts

Statistics

Verbal and written communication

Computer literacy

Analytical problem solving

Formation

RN/LPN license or healthcare bachelor’s

Certification: CPC/CRC/RHIA/RHIT/CCS

Outils

Microsoft Office

Description du poste

Highmark Inc. is seeking a compliance/quality professional to work with departments across the organization. The role focuses on improving documentation and coding for ICD-10-CM, conducting audits, and educating providers on STARS, HEDIS, and HCC coding.

The position requires an RN/LPN license or healthcare degree, and applicable coding certifications. Candidates should have 3+ years in nursing or healthcare and 4 months to obtain certain certifications. Office-based with potential travel.