Clinical Quality Improvement RN Analyst

Highmark Health; United States; À distance; USD 73 000 - 97 000; Plein temps

Résumé du poste

Highmark Inc. seeks a healthcare quality professional to collaborate with compliance, process improvement, medical record review, and coding teams across product lines to enhance documentation and ICD-10-CM coding for members.

The role supports STARS and value-based care initiatives, conducts audits, site visits, and training for providers, and coordinates credentialing-related activities to ensure quality outcomes across programs.

Qualifications

• Current state RN or LPN license or a Bachelor’s degree in a healthcare-related field.
• 3 years of nursing or healthcare-related field.

Responsabilités

• Develop and manage process improvement initiatives from the Organization for member and providers to include detailed data analysis, process analysis, report generation, medical record documentation, and HCC Coding.
• Conduct, collect and analyze information and data from office site and/or medical record reviews to continually improve the care, services, proper documentation and coding for members, to properly assign ICD10-CM codes to chronic conditions, and coordination with the revenue programs, credentialing and quality improvement programs to improve STARS, value-based care and achieve and maintain accreditation.
• Monitor changes, corrections and clarifications in applicable regulatory/accrediting body requirements and make adjustments to the compliance plan to follow CMS Coding Guidelines.
• Conduct retrospective, concurrent, and prospective, semi-annual, and annual audits, identify gaps and communicate results. Conduct continuing education to providers on STARS, HEDIS, and HCC Coding. Conduct re-audits as needed
• Other duties as assigned or requested.

Connaissances

Quality improvement

HCC Coding

Regulatory compliance

Data analysis

Formation

Bachelor’s degree in Healthcare-related field

Outils

MS Office

Description du poste

Highmark Inc. seeks a healthcare quality professional to collaborate with compliance, process improvement, medical record review, and coding teams across product lines to enhance documentation and ICD-10-CM coding for members.

The role supports STARS and value-based care initiatives, conducts audits, site visits, and training for providers, and coordinates credentialing-related activities to ensure quality outcomes across programs.