Remote Clinical Quality & Coding Improvement Analyst

Highmark Health; Pennsylvania; Hybrid; USD 63.000 - 97.000; Vollzeit

Zusammenfassung

Highmark Inc. is seeking a healthcare quality and compliance professional to lead process improvement, medical record review and coding support across product lines.

This role partners with compliance, process improvement, and clinical teams to enhance documentation, ICD-10-CM coding accuracy, and member/provider satisfaction. The ideal candidate has current RN/LPN license or a healthcare-related Bachelor's degree, plus 3 years of nursing or healthcare experience, and eligible for relevant

Qualifikationen

• Required: 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, or healthcare-related field in lieu of bachelor’s degree.

Aufgaben

• Develop and manage process improvement initiatives with detailed data analysis and reporting.
• Conduct medical record reviews to ensure accurate ICD-10-CM coding and documentation.
• Educate providers and office staff on documentation standards and CMS/HEDIS requirements.
• Coordinate credentialing, re-credentialing, and quality improvement activities as needed.

Kenntnisse

TQM concepts

Statistics

Verbal communication

Written communication

Interpersonal with medical admins

Computer literacy

MS Office

Analytical thinking

Ausbildung

RN or LPN license or Bachelor's in healthcare

Tools

Microsoft Office suite

Jobbeschreibung

Highmark Inc. is seeking a healthcare quality and compliance professional to lead process improvement, medical record review and coding support across product lines.

This role partners with compliance, process improvement, and clinical teams to enhance documentation, ICD-10-CM coding accuracy, and member/provider satisfaction. The ideal candidate has current RN/LPN license or a healthcare-related Bachelor's degree, plus 3 years of nursing or healthcare experience, and eligible for relevant