Director Risk Adjustment, Coding & Quality - Highmark : Job Details

This job develops and implements longterm strategy to achieve continuous improvements as it relates to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and laws established by the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), and others established at the state and federal levels. Drives efficient operational functions to achieve established Quality measures, STARS and HEDIS performance ratings. Directs and manages team of ~75 employees that are health plan and communitybased (embedded into provider systems) to deliver the highest quality of care to Highmark members and improve clinical documentation accuracy and completeness. Creates a culture focused on Compliance and Core Behaviors. Builds strong partnerships with Highmark crossfunctional teams including Care Management, STARS, Compliance, clinical leadership of health syste...Risk, Director, Improvement Specialist, Quality, Operations, Health, Accounting, Healthcare