Clinical Quality & Coding Compliance Analyst

Highmark Health; Salem (NH); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health seeks a quality and compliance professional to lead process improvements, enhance medical record documentation, and ensure accurate ICD-10-CM coding across products. You will educate providers, perform audits, and coordinate credentialing and site visits to support value-based care initiatives.

Responsibilities include data analysis, reporting, and continuous education on HEDIS/STARS metrics, with emphasis on timely, accurate documentation and coding.

Qualifications

• Current state RN or LPN license or Bachelor’s degree in a Healthcare-related field.
• Substitutions: ~6 years of experience with HEDIS/Quality abstraction, HCC Coding or healthcare field in lieu of bachelor’s degree.
• Preference for RN with active compact license; project management and Medicaid/Medicare experience are a plus.
• Licensure/certification required within specified timeframe after hire.

Responsibilities

• Develop and manage quality/process improvement initiatives across departments.
• Analyze data from office/site reviews to improve documentation and coding (ICD10-CM).
• Educate providers/office staff on STARS, HEDIS, and HCC Coding; conduct audits and re-audits.
• Coordinate credentialing, investigations, site visits, and related reviews as requested.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Analytical skills

Problem solving

Education

RN license (state)

LPN license (state)

Bachelor’s degree in healthcare

6 years related experience in lieu of degree

CPC/CRC/RHIA/RHIT/CCS certification

Job description

Highmark Health seeks a quality and compliance professional to lead process improvements, enhance medical record documentation, and ensure accurate ICD-10-CM coding across products. You will educate providers, perform audits, and coordinate credentialing and site visits to support value-based care initiatives.

Responsibilities include data analysis, reporting, and continuous education on HEDIS/STARS metrics, with emphasis on timely, accurate documentation and coding.