Healthcare Quality & Compliance Strategist

Highmark Health; Nebraska; À distance; USD 63 000 - 97 000; Plein temps

Résumé du poste

Highmark Health is seeking a quality and coding professional to support compliance, process improvement, and medical record review across product lines. The role focuses on improving documentation and ICD-10-CM coding while aligning with CMS and NCQA standards.

The position leads audits, provider education on STARS and HEDIS, and collaborates with credentialing and quality programs to enhance care quality and accreditation readiness.

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, or healthcare field in lieu of bachelor’s degree
• Demonstrated knowledge of CMS/NCQA standards and quality improvement principles

Responsabilités

• Develop and manage process improvement initiatives with data analysis, reporting, documentation, and HCC Coding
• Analyze data from office/site reviews to improve care, documentation, and coding for members
• Monitor regulatory/certification changes and adjust the compliance plan to CMS guidelines
• Conduct audits (retrospective, concurrent, prospective) and communicate results; provide provider education on STARS, HEDIS, and HCC coding
• Perform other duties as assigned or requested

Connaissances

TQM concepts

Statistics

Communication

MS Office

Data analysis

Formation

RN/LPN license or health-related bachelor's

6 years HEDIS/Quality abstraction or coding alternative

Outils

Microsoft Word

Microsoft Excel

Microsoft Access

PowerPoint

Description du poste

Highmark Health is seeking a quality and coding professional to support compliance, process improvement, and medical record review across product lines. The role focuses on improving documentation and ICD-10-CM coding while aligning with CMS and NCQA standards.

The position leads audits, provider education on STARS and HEDIS, and collaborates with credentialing and quality programs to enhance care quality and accreditation readiness.