LogoFresh Jobs Ahead
Highmark Health
Highmark Health
Sponsor pentru viza H1BAsigurăriConsultanțăLogistică
Highmark Health este o organizație din domeniul sănătății, axată pe îmbunătățirea modului în care oamenii accesează și experimentează serviciile de îngrijire medicală. Activitatea sa cuprinde servicii clinice, tehnologie, finanțe, marketing și alte funcții care sprijină furnizarea de servicii medicale. În calitate de licențiat independent al Blue Cross Blue Shield Association, compania reunește o gamă largă de profesioniști pentru a contribui la evoluția sistemului de sănătate. Highmark Health pune, de asemenea, accent pe diversitate, echitate și incluziune și a fost recunoscută pentru incluziunea persoanelor cu dizabilități și pentru statutul de angajator favorabil membrilor și veteranilor forțelor armate.
LinkedIn
Locurile de muncă ale companiei

Clinical Quality Management Analyst - Pennsylvania Remote

Clinical Quality Management Analyst responsible for healthcare quality improvement, medical coding, audits, and accreditation activities. Supports Highmark Health members, providers, and value-based care programs.

USStatele Unite ale AmericiiPAPennsylvania
62.700 $ – 97.200 $ / an
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăAnalist de afaceri

Descriere

  • Lead process improvement initiatives serving members and providers
  • Analyze data and processes, prepare reports, document medical records, and perform HCC coding
  • Gather and evaluate information from office-site and medical-record reviews
  • Enhance member care, services, documentation, and coding practices
  • Assign ICD-10-CM codes to chronic conditions
  • Partner with revenue, credentialing, and quality improvement teams to strengthen STARS and value-based care programs and support accreditation
  • Track updates from regulatory and accrediting organizations
  • Revise compliance plans to align with CMS Coding Guidelines
  • Perform retrospective, concurrent, prospective, semi-annual, and annual audits
  • Recognize performance gaps and communicate audit findings
  • Provide ongoing provider education on STARS, HEDIS, and HCC coding
  • Complete re-audits when required
  • Coordinate credentialing and re-credentialing, member complaint investigations, Medical Director and facility site-visit requests, reviews, audits, and accreditation activities as assigned
  • Handle additional duties as assigned or requested

Cerințe

  • An active state RN or LPN license, or a bachelor's degree in a healthcare-related field
  • Six years of experience in HEDIS or quality abstraction, HCC or medical coding, or a healthcare-related field may substitute for a bachelor's degree
  • Three years of nursing or healthcare-related experience
  • Active state RN or LPN licensure, multi-state licensure through the enhanced Nurse Licensure Compact (eNLC), or CPC, CRC, RHIA, RHIT, or CCS certification
  • CPC, CRC, RHIA, RHIT, or CCS certification may be earned within four months of hire
  • Knowledge of Total Quality Management principles, methods, and process and outcome measurement
  • Statistics knowledge preferred for report analysis and study-methodology validation
  • Strong verbal and written communication skills with a professional approach
  • Ability to communicate effectively with medical administrators, including Medical Directors and Physician Advisors
  • Computer proficiency and familiarity with information systems and comparative databases
  • Working knowledge of Microsoft Office, including Word, Excel, Access, and PowerPoint
  • Strong analytical and problem-solving abilities, including the ability to interpret clinical data
  • English is the only required language

Beneficii

  • Remote work arrangement
  • Travel expectation of 0% to 25%

Locuri de muncă similare