Clinical Quality & Coding Improvement Analyst

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

Job summary

Highmark Health seeks a quality improvement professional to optimize documentation and coding for diverse product lines. You will lead data-driven process improvements, perform audits, and educate providers on CMS/HEDIA standards, STARS, and HCC coding with coordination across credentialing and quality programs.

The role emphasizes collaboration with compliance, process improvement, and medical record review to enhance patient care and regulatory adherence.

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/medical coding, or healthcare field in lieu of bachelor’s degree.
• Preferred: None

Responsibilities

• Develop and manage process improvements for member and provider care and documentation, including ICD-10-CM coding.
• Conduct audits (retrospective, concurrent, prospective) and identify gaps with clear results.
• Educate providers on STARS, HEDIS, and HCC Coding; coordinate with credentialing and quality programs.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Clinical data analysis

Education

RN or LPN license or Healthcare-related Bachelor's

CPC/CRC/RHIA/RHIT/CCS Certification

Job description

Highmark Health seeks a quality improvement professional to optimize documentation and coding for diverse product lines. You will lead data-driven process improvements, perform audits, and educate providers on CMS/HEDIA standards, STARS, and HCC coding with coordination across credentialing and quality programs.

The role emphasizes collaboration with compliance, process improvement, and medical record review to enhance patient care and regulatory adherence.