Coding Compliance Specialist - (HEDIS)
Requisition #: 291986
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Nov. 3, 2020
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.
Uses coding expertise to ensure appropriate codes are set up by specialty and/or plan. Monitors annual code changes implemented by CMS and Ingenics, using these data sources to determine annual rates for JHHC plans and providers. Assists HEDIS Manager and Clinical staff with specific elements of the EMR Standard Supplemental Data Process and performs data abstraction and documentation from medical records as appropriate.
The HEDIS Coding Compliance Specialist is responsible for assisting the HEDIS Manager and Clinical Quality Management Nursing Staff with specific elements of the EMR Standard Supplemental Data Process and performs data abstraction and documentation from medical records as appropriate. This includes the annual project and prospective review process. This role is a critical support to HEDIS efforts to ensure that JHHC meets and exceeds benchmarks as prescribed by the National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid (CMS). HEDIS is a critical function that comprises a large number of points needed for NCQA accreditation. HEDIS is also critical to the Maryland Department of Health Value Based Purchasing (VBP) measures as well as CMS Star ratings.
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.
Johns Hopkins Medicine.