Clinical Quality & Coding Analyst

Highmark Health

Central City (KY)

Remote

USD 63,000 - 97,000

Full time

6 days ago

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Job summary

Highmark Health is seeking a quality improvement and coding professional to lead process improvement initiatives across departments. You will analyze data, review medical records, and ensure accurate ICD-10-CM coding for members and providers.

The role requires RN/LPN license or healthcare-related degree, with experience in HEDIS/HCC and a strong understanding of CMS/NCQA guidelines. Travel and site visits may be involved as part of audits and accreditation activities.

Qualifications

Current state RN or LPN license OR health-care related bachelor's degree.
6 years of experience with HEDIS/Quality abstraction, HCC coding, or healthcare field in lieu of degree.
Familiarity with CMS/NCQA standards and HIPAA compliance.

Responsibilities

Develop and manage process improvement initiatives with detailed data analysis.
Conduct data collection, office site/medical record reviews to improve care and coding.
Educate providers on STARS, HEDIS, and HCC Coding; perform re-audits as needed.
Monitor regulatory/accrediting changes and update compliance plans accordingly.
Coordinate credentialing and related quality improvement activities.