Clinical Quality & Compliance Analyst

Highmark Health; Montana City (MT); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health is seeking a qualified professional to lead quality improvement efforts, oversee medical record documentation, and ensure accurate ICD-10-CM coding across product lines. You will collaborate with compliance, process improvement, and credentialing teams to drive STARS and value-based care initiatives.

The role requires nursing or healthcare experience, current licensure, and knowledge of coding guidelines.

Qualifications

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

Responsibilities

• Develop and manage quality process improvements with data analysis and reporting.
• Conduct audits of records to improve documentation and coding.
• Ensure CMS and regulatory coding guidelines are followed.
• Educate providers on STARS, HEDIS, and HCC coding.
• Coordinate credentialing, audits, and related reviews.

Skills

Quality improvement

HCC Coding

ICD-10-CM coding

Data analysis

Communication skills

Microsoft Office

Education

Current RN or LPN license or healthcare bachelor’s degree

Bachelor’s degree in healthcare-related field

Tools

Microsoft Office

Job description

Highmark Health is seeking a qualified professional to lead quality improvement efforts, oversee medical record documentation, and ensure accurate ICD-10-CM coding across product lines. You will collaborate with compliance, process improvement, and credentialing teams to drive STARS and value-based care initiatives.

The role requires nursing or healthcare experience, current licensure, and knowledge of coding guidelines.