This leadership role involves managing Risk Adjustment and Quality/HEDIS activities. Responsibilities include directing daily operations of the Risk Adjustment Coding and Quality/HEDIS teams, assessing and improving processes, ensuring compliance with government and regulatory audits, coordinating audit and accreditation activities, and conducting specialized provider education on Risk Adjustment and Quality/HEDIS measures. The role also involves developing and implementing education related to medical record documentation and coding, overseeing audits to improve care and member satisfaction, participating in cross-functional initiatives, and ensuring ongoing compliance with regulations.
Bachelor's Degree in a Health related field or current state RN/LPN license, or 6 years combined experience with RN/LPN, Risk Adjustment, HCC coding, medical coding/billing, HEDIS, and/or healthcare related management. Required experience includes 3 years working within government markets and compliance/coding guidelines, and 1 year in a management or leadership role. Preferred experience includes 3 years clinical nursing (RN or LPN), 3 years in health insurance, mentoring others, project management, Total Quality Management concepts, and familiarity with Healthcare Effectiveness Data and Information Set (HEDIS). Certifications required: CPC, CCS, RHIA, or Clinical Research Coordinator; Preferred: LPN or RN.
Competitive salary range from $86,400 to $138,600 annually. Remote work option available. Opportunities to lead and innovate in healthcare quality and risk adjustment processes. Access to training and professional development. Highmark Health offers a strong, stable financial background and a culture of compassionate care and community investment.
Location
Pennsylvania, US
Employment Type
Full-time
Experience Level
Manager
Salary Range
$86,400 - $138,600
Remote work allowed
Yes
Posted
1 month ago