Quality Management Analyst - Medical Records & Coding

Highmark Health; Beryl (WV); A distancia; USD 63.000 - 97.000; Jornada completa

Descripción de la vacante

Highmark Health is seeking a Quality & Compliance professional to work with multiple departments on process improvements, documentation, and ICD-10-CM coding to enhance member care. The role emphasizes education for providers, adherence to CMS/NCQA standards, and ongoing audits.

Requirements include an RN/LPN license or healthcare bachelor’s, 3 years of healthcare experience, and coding certifications with a 4-month transition window. Travel and office-based work may occur.

Formación

• Current state RN or LPN license or Bachelor’s degree in a healthcare-related field.
• 3 years of nursing or healthcare-related experience.
• Certification: CPC, CRC, RHIA, RHIT or CCS or must obtain within 4 months after hire.

Responsabilidades

• Develop and manage process improvement initiatives with data analysis and coding guidance for members and providers.
• Analyze office site and medical record reviews to improve care, documentation, and ICD-10-CM coding.
• Monitor regulatory and accrediting body requirements and adjust the compliance plan accordingly.
• Conduct audits (retrospective, concurrent, prospective) and provide ongoing clinician education on STARS, HEDIS, and HCC coding.
• Coordinate credentialing/recertification activities and related reviews as requested.

Conocimientos

TQM concepts

Statistics

Verbal communication

Written communication

Communication with Medical Directors

IT literacy

MS Office (Word, Excel, Access, PowerP

Analytical problem solving

Educación

RN or LPN license or healthcare-related Bachelor's

HEDIS/Quality abstraction or HCC coding experience (in lieu of degree)

Herramientas

Microsoft Office

Healthcare data systems

Descripción del empleo

Highmark Health is seeking a Quality & Compliance professional to work with multiple departments on process improvements, documentation, and ICD-10-CM coding to enhance member care. The role emphasizes education for providers, adherence to CMS/NCQA standards, and ongoing audits.

Requirements include an RN/LPN license or healthcare bachelor’s, 3 years of healthcare experience, and coding certifications with a 4-month transition window. Travel and office-based work may occur.