Quality & Compliance Analyst (HEDIS, HCC Coding)

Highmark Health; Arkansas City (KS); À distance; USD 63 000 - 97 000; Plein temps

Résumé du poste

Highmark Health is seeking a qualified professional to join our quality improvement team, focusing on data analysis, HCC coding, and regulatory alignment to enhance member outcomes and documentation quality. The role supports STARS, MHC coding, and accreditation initiatives while coordinating audits and education for providers and staff.

Required are an active RN/LPN license or healthcare degree, 3 years in healthcare, and relevant certifications; experience with HEDIS, coding, and managed care

Qualifications

• Current state RN or LPN license or Bachelor’s degree in a Healthcare-related field.
• Substitutions: 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare related field in lieu of bachelor's degree.
• RN with an active compact license preferred.

Responsabilités

• Develop and manage process improvement initiatives for members and providers with data analysis, reporting, and documentation.
• Improve ICD-10-CM coding accuracy and coordination with revenue, credentialing, and quality programs.
• Conduct audits (retrospective, concurrent, prospective) and provide continuing education on STARS, HEDIS, and HCC Coding.
• Perform site visits, medical record reviews, and support credentialing activities as requested.

Formation

RN/LPN license or healthcare bachelor

Substitution: 6 years HEDIS/QA abstraction or related field

Outils

MS Office (Word, Excel, Access, PowerPoint)

Description du poste

Highmark Health is seeking a qualified professional to join our quality improvement team, focusing on data analysis, HCC coding, and regulatory alignment to enhance member outcomes and documentation quality. The role supports STARS, MHC coding, and accreditation initiatives while coordinating audits and education for providers and staff.

Required are an active RN/LPN license or healthcare degree, 3 years in healthcare, and relevant certifications; experience with HEDIS, coding, and managed care