Quality & Coding Compliance Analyst

Highmark Health; Idaho Falls (ID); A distancia; USD 63.000 - 97.000; Jornada completa

Descripción de la vacante

Highmark Inc. in Idaho Falls is seeking a healthcare quality and compliance professional to collaborate with Compliance, Process Improvement, medical record review, coding, and member/provider satisfaction across all product lines.

You will lead data analysis, audits, and education on STARS, HEDIS, and HCC Coding, coordinate credentialing activities, and help ensure documentation and coding meet CMS/NCQA standards.

Formación

• 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.
• 1 year of project management experience.
• Medicaid/Medicare experience.
• Preferred experience with Managed Care Organizations.
• CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire.
• RN with an active compact license.

Responsabilidades

• 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.

Conocimientos

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Analytical problem-solving

Educación

RN or LPN license or healthcare related bachelor's

CPC/CRC/RHIA/RHIT/CCS certification

Descripción del empleo

Highmark Inc. in Idaho Falls is seeking a healthcare quality and compliance professional to collaborate with Compliance, Process Improvement, medical record review, coding, and member/provider satisfaction across all product lines.

You will lead data analysis, audits, and education on STARS, HEDIS, and HCC Coding, coordinate credentialing activities, and help ensure documentation and coding meet CMS/NCQA standards.