LogoFresh Jobs Ahead
Highmark Health
Highmark Health
H1B vizasi homiysiKonsaltingLogistikaSug‘urta
Highmark Health odamlarning tibbiy yordamni qanday qabul qilishi va undan qanday foydalanishini yaxshilashga e’tibor qaratadigan sog‘liqni saqlash tashkilotidir. Uning faoliyati tibbiy xizmatlarni ko‘rsatishni qo‘llab-quvvatlaydigan klinik xizmatlar, texnologiya, moliya, marketing va boshqa funksiyalarni qamrab oladi. Blue Cross Blue Shield Association’ning mustaqil litsenziya egasi sifatida kompaniya sog‘liqni saqlash tizimini rivojlantirishga yordam berish uchun turli sohalardagi keng doiradagi mutaxassislarni birlashtiradi. Highmark Health xilma-xillik, tenglik va inklyuziyaga ham katta ahamiyat beradi hamda nogironligi bo‘lgan shaxslarni qo‘llab-quvvatlash va harbiy xizmatchilar uchun qulay ish beruvchi sifatida e’tirof etilgan.
LinkedIn
Kompaniyadagi ish o‘rinlari

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.

USAmerika Qo‘shma ShtatlariPAPensilvaniya
62 700 $ – 97 200 $ / yil
MasofaviyTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaBiznes tahlilchisi

Tavsif

  • 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

Talablar

  • 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

Imtiyozlar

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

O‘xshash ish o‘rinlari

SouthState Bank

Remote Customer Care Representative I

SouthState Bank
1 001 – 5 000 Xodimlar
Bank ishiFintexMoliya
USAmerika Qo‘shma ShtatlariALAlabamaCOKoloradoFLFloridaNCShimoliy KarolinaSCJanubiy KarolinaTXTexasVAVirjiniya
33 664 $ – 50 496 $ / yil
MasofaviyTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaMijozlarni qo‘llab-quvvatlash

Handle SouthState Bank customer inquiries about accounts, digital banking, and debit cards in a remote role. Provide secure, personalized service through inbound calls and banking systems.

Ochish