Clinical Quality & Coding Analyst

Highmark Health; Bastrop (LA); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health is seeking a Quality Improvement professional to lead process improvements across compliance, coding and member/provider satisfaction. You will improve documentation and ICD-10-CM coding, support STARS/HEDIS initiatives, and coordinate credentialing activities while auditing and educating staff.

The role involves collaborating with multiple departments and performing site visits to ensure timely, accurate medical record reviews and coding enhancements.

Qualifications

• Understanding of TQM concepts and study methodologies.
• Strong communication skills with medical administrators.
• Experience with clinical data and coding concepts preferred.
• Proficiency with Microsoft Office suite and data analysis.

Responsibilities

• Develop and manage process-improvement initiatives across member and provider services.
• Analyze data from office/site reviews to improve care, documentation, and coding.
• Conduct audits and re-audits; identify gaps and report results.
• Educate providers on STARS, HEDIS, and HCC coding; coordinate credentialing activities.

Skills

TQM concepts

Process measurement

Statistics understanding

Verbal communication

Written communication

Professional demeanor

Communication with medical admins

MS Office proficiency

Analytical/problem-solving skills

Clinical data interpretation

Education

RN or LPN license or healthcare-related Bachelor's

Tools

Microsoft Office

Job description

Highmark Health is seeking a Quality Improvement professional to lead process improvements across compliance, coding and member/provider satisfaction. You will improve documentation and ICD-10-CM coding, support STARS/HEDIS initiatives, and coordinate credentialing activities while auditing and educating staff.

The role involves collaborating with multiple departments and performing site visits to ensure timely, accurate medical record reviews and coding enhancements.