Clinical Quality & Compliance Analyst

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

Job summary

Highmark Health is seeking a Healthcare Quality Improvement specialist to collaborate with compliance, process improvement, and medical record review teams. The role focuses on improving documentation, ICD-10-CM coding, and provider education across all product lines.

The position requires RN/LPN licensure or a healthcare bachelor’s degree, with experience in HEDIS/quality abstraction and HCC coding, and strong data analysis skills. Office-based with travel up to 25%.

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 experience in the required area

Responsibilities

• Develop and manage process improvement initiatives with data analysis, process analysis, reporting, documentation, and HCC Coding.
• Conduct information and data collection from office/site reviews to improve care, documentation, and coding for members; coordinate with revenue, credentialing and quality programs.
• Monitor regulatory/accrediting body requirements and adjust the compliance plan to CMS Coding Guidelines.
• Conduct various audits and provide continuing education to providers on STARS, HEDIS, and HCC Coding.

Skills

Total Quality Management

Statistics

Verbal communication

Written communication

Microsoft Office

Analytical/problem-solving skills

Education

RN or LPN license

Bachelor’s degree in healthcare

6 years HEDIS/Quality abstraction or HCC Coding experience

Tools

Microsoft Office

Job description

Highmark Health is seeking a Healthcare Quality Improvement specialist to collaborate with compliance, process improvement, and medical record review teams. The role focuses on improving documentation, ICD-10-CM coding, and provider education across all product lines.

The position requires RN/LPN licensure or a healthcare bachelor’s degree, with experience in HEDIS/quality abstraction and HCC coding, and strong data analysis skills. Office-based with travel up to 25%.