Claims Review/Quality Improvement Coordinator

Claims Review/Quality Improvement Coordinator

 

HealthAmerica, a leading provider of managed care in Pennsylvania, seeks to fill the position of Claims Review/Quality Improvement Coordinator at our Pittsburgh location. If you are looking for a company that rewards employees based on contribution and performance, provides flexible scheduling, tools to succeed, and creates a team-focused, high-energy environment, consider us! 

 

Responsible for accurate data collection, data entry & analysis as part of defined HEDIS and coding compliance initiatives.  

 

ESSENTIAL RESPONSIBILITIES:

 

• Performs coding & claims reviews in physician offices, under the direction of the Health Services management team.

 

• Data collection in physician offices for defined HEDIS and quality initiatives

 

• Assists in conducting HEDIS related peer review chart audits & compiling statistics

 

• Assists in data entry and analysis 

 

• Prepares and discuss weekly/monthly reports with management and physician practices

 

• Conducts physician outreach/education related to the HCC coding initiative

 

• Identify candidates and make referrals to CM/DM as applicable

 

• Performs all other duties as required. 

 

JOB SPECIFICATIONS:

 

• Current Pennsylvania state LPN or RN license required.

 

• Previous (2-4 years) clinical experience required.

 

• Medical Office (2+ years) experience strongly preferred

 

• Expert knowledge of medical terminology, ICD-9, CPT-4 and HCPCS coding

 

• Certification (CPC-H) highly desired

 

• Previous experience with HEDIS medical record review preferred.

 

• Previous experience in a managed care organization preferred.

 

• Bachelor’s degree preferred.

 

• Excellent communication/presentation, organizational, analytical and computer skills.

 

• Valid driver’s license and reliable vehicle required

 

• Ability to lift at least 25 pounds.  

 

We offer a competitive salary and a comprehensive benefits package. To be considered for this opportunity, applicants must apply online at our Career Center at http://careers.cvty.com and refer to Job Requisition #85717. Our Career Center will allow you to create an on-line profile, apply for open positions, and even receive customized email notifications when new positions of interest become available. EOE/AA