Clinical Quality & Coding Improvement Analyst

Highmark Health; Iowa Center (IA); Hybrid; USD 63,000 - 97,000; Full time

Job summary

Highmark Health is seeking a Quality Improvement professional to collaborate with compliance, process improvement, and coding teams. The role focuses on improving documentation, ICD-10-CM coding, and adherence to CMS/NCQA standards through audits and education.

You will participate in STARS and value-based care initiatives, coordinate credentialing tasks, and support provider education. This role requires clinical licensure and healthcare experience with a focus on quality improvement.

Qualifications

• RN or LPN license or healthcare-related Bachelor's degree is required.
• 3 years of nursing or healthcare-related experience is required.
• Certification or licensure (CPC, CRC, RHIA, RHIT, CCS) or must obtain within 4 months of hire.
• Strong knowledge of HEDIS, STARS and HCC coding is preferred.
• Experience with healthcare regulatory standards and quality improvement is preferred.

Responsibilities

• Develop and manage process improvement initiatives for member/provider care and documentation.
• Perform medical record reviews and coding for ICD-10-CM to support accuracy and optimization.
• Educate providers on STARS, HEDIS and HCC coding practices.
• Conduct audits, site visits, and re-audits to verify improvements and compliance.
• Coordinate credentialing, credentialing appeals, and related quality activities as needed.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Data analysis

Clinical data interpretation

Education

RN or LPN license or healthcare Bachelor's

Job description

Highmark Health is seeking a Quality Improvement professional to collaborate with compliance, process improvement, and coding teams. The role focuses on improving documentation, ICD-10-CM coding, and adherence to CMS/NCQA standards through audits and education.

You will participate in STARS and value-based care initiatives, coordinate credentialing tasks, and support provider education. This role requires clinical licensure and healthcare experience with a focus on quality improvement.