Registered Nurse Quality Review Specialist - CIC or CCS
Highmark Health(29 days ago)
About this role
A clinician-level role within Highmark’s payment integrity function focused on ensuring the accuracy and compliance of previously adjudicated medical claims. The position centers on validating clinical coding and reimbursement determinations for provider-submitted appeals and supporting overall claims integrity. It contributes clinical and coding expertise to uphold regulatory and quality standards.
Required Skills
- Clinical Knowledge
- Medical Coding
- ICD-10-CM
- ICD-10-PCS
- Appeals Preparation
- Regulatory Compliance
- Analytical Skills
- Communication Skills
- Documentation
- EHR Systems
Qualifications
- Associate's Degree in Science of Nursing
- Bachelor's Degree in Science of Nursing (Preferred)
- PA RN Licensure or eNLC Multi-State Licensure
- Certified Inpatient Coder (CIC)
- Certified Coding Specialist (CCS)
About Highmark Health
highmarkhealth.orgA national health and wellness organization as well as the second largest integrated delivery and financing system in America.
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