Clinical Quality & Coding Analyst

Highmark Health; Oklahoma; Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health is seeking a quality-focused professional to collaborate with compliance, process improvement, medical record review, and coding teams across product lines. You will drive improvements in documentation, ICD-10-CM coding, and provider education to support CMS/NCQA standards and STARS performance.

You will conduct audits (retrospective, concurrent, prospective), site visits, and data analyses, and may assist with credentialing activities, ensuring timely, accurate care

Qualifications

• 3 years of nursing or healthcare-related field.
• 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare related field in lieu of bachelor's degree
• Current state RN or LPN license or Bachelor's degree in a Healthcare-related field

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting.
• Analyze medical record reviews to improve documentation and coding accuracy.
• Educate providers on STARS, HEDIS, and HCC coding.
• Conduct audits, site visits, and re-audits as needed.
• Coordinate credentialing and related quality improvement activities.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Data analysis

Problem solving

Clinical data interpretation

Education

RN/LPN license or healthcare degree

Tools

Microsoft Office

Job description

Highmark Health is seeking a quality-focused professional to collaborate with compliance, process improvement, medical record review, and coding teams across product lines. You will drive improvements in documentation, ICD-10-CM coding, and provider education to support CMS/NCQA standards and STARS performance.

You will conduct audits (retrospective, concurrent, prospective), site visits, and data analyses, and may assist with credentialing activities, ensuring timely, accurate care