Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers.
Track and resolve denials, rejections, and underpayments with follow-up and resubmission.
Collaborate with providers and operations to optimize coding, documentation, and billing workflows.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. It is a startup delivering 24/7 virtual-first and in-home care, with a culture centered on innovation, diversity, and compassion.
Develop and lead the enterprise HEDIS strategy, including measures influencing Medicare Advantage Star Ratings.
Oversee the full HEDIS lifecycle from data acquisition to audit readiness and digital quality measurement.
Build cross-functional improvement initiatives and provider performance strategies to drive quality outcomes.
Capital Blue Cross is a health insurance company and independent licensee of the Blue Cross Blue Shield Association, focused on improving the health and well-being of its members and communities. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."
Lead quality program management activities to ensure compliance with state, federal, and NCQA requirements.
Oversee complex quality deliverables including audits, accreditation surveys, and performance reports.
Collaborate with quality leadership and cross-functional teams to monitor performance and drive continuous improvement.
This organization partners with health plans to implement quality improvement programs and ensure compliance with regulatory standards such as NCQA and HEDIS. The culture emphasizes collaboration, regulatory excellence, and continuous improvement, with a remote work environment for professionals based in Michigan.