Quality & Compliance Analyst - HEDIS, ICD-10 & Audits

Highmark Health; Sacramento (CA); Teletrabalho; USD 63 000 - 97 000; Tempo integral

Resumo da oferta

Highmark Inc. in California is seeking a healthcare quality/compliance professional to work with compliance, process improvement, medical record review, and coding. You will improve documentation and coding, educate providers on standards, and support STARS/HEDIS initiatives.

The role involves audits and occasional site visits within California. Requirements include an RN/LPN license or healthcare degree, 3 years of healthcare experience, and familiarity with HEDIS/HCC coding.

Qualificações

• This role requires RN or LPN licensure or a healthcare degree.
• Substitutions may replace a bachelor's degree with 6 years of relevant experience.
• Experienced candidates may have PM experience and Medicaid/Medicare exposure.
• Preference for candidates with Managed Care Organization experience.

Responsabilidades

• Develop and manage process-improvement initiatives with data analysis and reporting.
• Analyze medical records to improve care, documentation, and coding.
• Monitor regulatory changes and adjust the compliance plan accordingly.
• Conduct audits and communicate results to stakeholders.
• Provide continuing education to providers on STARS, HEDIS, and HCC Coding.
• Perform re-audits as needed.
• Assist with other duties as assigned.

Conhecimentos

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Data analysis

Problem solving

Documentation

Formação académica

RN or LPN license

Bachelor’s degree in healthcare

Substitutions: 6 years experience

Experience: 3 years nursing/healthcare

PM experience (1 year)

Medicaid/Medicare experience

Managed Care Organizations experience

Descrição da oferta de emprego

Highmark Inc. in California is seeking a healthcare quality/compliance professional to work with compliance, process improvement, medical record review, and coding. You will improve documentation and coding, educate providers on standards, and support STARS/HEDIS initiatives.

The role involves audits and occasional site visits within California. Requirements include an RN/LPN license or healthcare degree, 3 years of healthcare experience, and familiarity with HEDIS/HCC coding.