LogoFresh Jobs Ahead
Highmark Health
Highmark Health
Sponzor vizuma H1BLogistikaSvetovanjeZavarovanje
Highmark Health je zdravstvena organizacija, osredotočena na izboljšanje načina, kako ljudje doživljajo zdravstveno oskrbo in dostopajo do nje. Njeno delo zajema klinične storitve, tehnologijo, finance, trženje in druga področja, ki podpirajo zagotavljanje zdravstvene oskrbe. Kot neodvisni imetnik licence združenja Blue Cross Blue Shield Association podjetje združuje širok nabor strokovnjakov, ki pomagajo razvijati zdravstveni sistem. Highmark Health poudarja tudi raznolikost, pravičnost in vključevanje ter je bilo prepoznano po vključevanju oseb z invalidnostmi in zaposlovanju, prijaznemu do pripadnikov vojske.
LinkedIn
Delovna mesta v podjetju

Clinical Quality Management Analyst, RN

Improve healthcare quality and compliance through clinical data analysis, medical record reviews, coding, audits, and accreditation work at Highmark Health. Support providers and quality initiatives with education and process improvement.

USZdružene države AmerikeALAlabamaAKAljaskaAZArizonaCAKalifornijaCOKoloradoCTConnecticutFLFloridaHIHavajiIDIdahoILIllinoisIAIowaKSKansasKYKentuckyLALouisianaMEMaineMDMarylandMAMassachusettsMIMichiganMNMinnesotaMSMisisipiMOMisuriNENebraskaNVNevadaNHNew HampshireNJNew JerseyNMNova MehikaNYNew YorkNCSeverna KarolinaNDSeverna DakotaOHOhioOKOklahomaOROregonPAPensilvanijaRIRhode IslandSCJužna KarolinaSDJužna DakotaTNTennesseeTXTeksasUTUtahVTVermontVAVirginijaWAWashingtonWVZahodna VirginijaWIWisconsinWYWyoming
62.700 $ – 97.200 $ / leto
Na lokacijiPolni delovni časSrednja ravenSeniorZahtevani Jezik: angleščinaPoslovni analitik

Opis

  • Partner with departments on compliance, process improvement, medical record reviews and coding, and member and provider satisfaction.
  • Recommend and implement improvements to quality care, member services, and ICD-10-CM documentation.
  • Advise and educate on medical record documentation, CMS and NCQA standards, and continuous quality improvement.
  • Conduct special studies, audits, office site visits, and medical record reviews.
  • Coordinate credentialing and re-credentialing, member complaint investigations, Medical Director and facility site visit requests, reviews, audits, and accreditation activities.
  • Develop and oversee improvement initiatives using data and process analysis, report generation, medical record documentation, and HCC coding.
  • Analyze office site and medical record review findings to improve care, services, documentation, coding, STARS, value-based care, credentialing, quality improvement, and accreditation.
  • Track regulatory and accrediting-body changes and update compliance plans in line with CMS Coding Guidelines.
  • Conduct retrospective, concurrent, prospective, semiannual, and annual audits; identify gaps and share results.
  • Educate providers on STARS, HEDIS, and HCC coding.
  • Conduct follow-up audits as needed.
  • Complete other assigned or requested duties.

Zahteve

  • Current state RN or LPN license, or a bachelor's degree in a healthcare-related field.
  • Six years of experience in HEDIS/quality abstraction, HCC or medical coding, or a healthcare-related field may substitute for a bachelor's degree.
  • Three years of experience in nursing or a healthcare-related field.
  • Current state RN or LPN license, multistate licensure through the enhanced Nurse Licensure Compact (eNLC), or CPC, CRC, RHIA, RHIT, or CCS certification; required certification or licensure must be obtained within four months of hire.
  • Understanding of Total Quality Management (TQM) concepts, techniques, and process and outcome measures.
  • Knowledge of statistics preferred for analyzing reports and validating study methods.
  • Strong verbal and written communication skills and a professional manner.
  • Ability to communicate with medical administrators, including Medical Directors and Physician Advisors, about identifying problems, implementing action plans, monitoring progress, and resolving issues.
  • Computer literacy and familiarity with information systems and comparative databases.
  • Working knowledge of Microsoft Office, including Word, Excel, Access, and PowerPoint.
  • Analytical and problem-solving skills, including the ability to understand and interpret clinical data.
  • Travel requirement of 0%–25%.
  • Physical work site required.

Sorodna delovna mesta

Kreato Global | BPO and Language Solutions

Remote English-Spanish OPI/VRI Interpreter

Kreato Global | BPO and Language Solutions
201 – 500 Zaposleni
GostinstvoLogistikaZdravstveno varstvo
ARArgentinaBOBolivijaBRBrazilijaCLČileCOKolumbijaCRKostarikaCUKubaDODominikanska republikaECEkvadorGTGvatemalaHNHondurasHTHaitiMXMehikaNINikaragvaPAPanamaPEPeruPRPortorikoPYParagvajSVSalvadorUYUrugvajVEVenezuelaNa daljavoPolni delovni časJuniorDiploma ni potrebnaZahtevani Jezik: angleščinaZahtevani Jezik: španščinaPrevajalec

Interpret remotely between English- and Spanish-speaking people in medical, financial, social service, and customer care settings. Provide language support for Kreato Global across Latin America.

Odpri
RecruitGo

Remote Executive Assistant, Outreach and Marketing — Philippines

RecruitGo
51 – 200 Zaposleni
LogistikaSvetovanjeTrženje
PHFilipini
45.000 ₱ / mesec
Na daljavoPolni delovni časJuniorSrednja ravenDiploma ni potrebnaZahtevani Jezik: angleščinaAsistent vodstva

Handle administrative support, CRM, outreach, and marketing for RecruitGo, an Employer of Record serving global clients with talent from emerging markets. Support two UK-facing clients with day-to-day administration and creative campaigns.

Odpri