Clinical Quality & Coding Improvement Analyst

Highmark Health; Athens (GA); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. seeks a quality improvement professional to collaborate across departments for member and provider care improvements. You will lead data-driven analyses, improve documentation, and ensure accurate ICD-10-CM coding while aligning with CMS/NCQA standards.

The role involves audits, education for providers on STARS and HCC coding, and coordination with credentialing and quality programs to improve outcomes across product lines.

Qualifications

• Current state RN or LPN license or Bachelor’s degree in a 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
• 3 years of nursing or healthcare-related field

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting for member/provider care
• Analyze office/site reviews to improve care, documentation and coding for chronic conditions
• Monitor regulatory/accrediting requirements and adjust the compliance plan accordingly
• Conduct audits and education on STARS, HEDIS, and HCC Coding; perform re-audits as needed

Skills

Quality improvement

Data analysis

Communication (verbal)

Communication (written)

Microsoft Office

Problem solving

Education

RN or LPN license or Bachelor's in healthcare

Tools

MS Office (Word)

Excel

Access

PowerPoint

Job description

Highmark Inc. seeks a quality improvement professional to collaborate across departments for member and provider care improvements. You will lead data-driven analyses, improve documentation, and ensure accurate ICD-10-CM coding while aligning with CMS/NCQA standards.

The role involves audits, education for providers on STARS and HCC coding, and coordination with credentialing and quality programs to improve outcomes across product lines.