Clinical Quality & Coding Improvement Analyst

Highmark Health

East Windsor Hill (CT)

Remote

USD 63,000 - 97,000

Full time

6 days ago

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Job summary

Highmark Health is seeking a quality-focused professional to collaborate with compliance, process improvement, and medical record review teams. The role focuses on improving documentation for ICD10-CM coding and contributing to STARS and value-based care initiatives.

The position requires an RN or LPN license or healthcare-related bachelor’s degree, and 3 years in nursing/healthcare plus familiarity with HEDIS and quality abstraction. A compact license and related certifications are preferred.

Qualifications

RN or LPN license or healthcare-related bachelor’s degree.
6 years of HEDIS/Quality abstraction or healthcare field in lieu of bachelor’s degree.
Experience in nursing or healthcare-related field is required.

Responsibilities

Develop and manage process improvement initiatives with data analysis, process analysis, report generation, medical record documentation, and HCC coding.
Conduct information/data collection from site reviews to improve documentation and coding for members; coordinate with revenue programs and accreditation bodies.
Educate providers on STARS, HEDIS, and HCC coding; perform re-audits as needed.
Conduct retrospective, concurrent, and prospective audits; identify gaps and communicate results.