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Senior Clinical Quality Management Analyst (Remote, Delaware) Performance Improvement Project Lead
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- Serves as a resource and educator regarding provider and office staff medical record documentation, federal and state standards including CMS and NCQA standards and continuous quality improvement principles.
- Develop and manage process improvement initiatives from the Organization for member and providers to include detailed data analysis, process analysis, report generation, medical record documentation, and HCC Coding.
- Conduct, collect and analyze information and data from office site and/or medical record reviews to continually improve the care, services, proper documentation and coding for members, to properly assign ICD10-CM codes to chronic conditions, and coordination with the revenue programs, credentialing and quality improvement programs to improve STARS, value based care and achieve and maintain accreditation.
- Conduct continuing education to providers on STARS, HEDIS, and HCC Coding.
- 6 years of combined experience with RN/LPN, Risk Adjustment HCC Coding, medical coding/billing, HEDIS, and/or health related field in lieu of bachelor's degree
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