Quality Improvement & Coding Analyst

Highmark Health; South Dakota; A distancia; USD 63.000 - 97.000; Jornada completa

Descripción de la vacante

Highmark Health is seeking a quality improvement professional to drive process improvement initiatives across departments, focusing on medical record documentation, HCC coding, and adherence to CMS/NCQA standards. The role includes conducting audits, education for providers, and supporting credentialing activities.

You will lead retrospective, concurrent, and prospective audits, track performance improvements, and collaborate with the revenue programs to enhance STARS and value-based care.

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, or healthcare related field in lieu of bachelor's degree.
• 3 years of nursing or healthcare-related field experience.
• Project management experience and Medicaid/Medicare experience preferred.
• Experience with Managed Care Organizations preferred.

Responsabilidades

• Develop and manage process improvement initiatives from the Organization for member and providers, including data analysis, process analysis, report generation, medical record documentation and HCC coding.
• Conduct information and data collection from office site and/or medical record reviews to improve care, services, documentation and coding for members; assign ICD-10-CM codes.
• Coordinate with credentialing and quality improvement programs to improve STARS and value-based care; ensure compliance with CMS guidelines; conduct audits and re-audits.

Conocimientos

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Analytical thinking

Educación

RN/LPN license OR healthcare Bachelor’s

eNLC multi-state licensure OR CPC/CRC/RHIA/RHIT/CCS

Descripción del empleo

Highmark Health is seeking a quality improvement professional to drive process improvement initiatives across departments, focusing on medical record documentation, HCC coding, and adherence to CMS/NCQA standards. The role includes conducting audits, education for providers, and supporting credentialing activities.

You will lead retrospective, concurrent, and prospective audits, track performance improvements, and collaborate with the revenue programs to enhance STARS and value-based care.