Clinical Quality & Compliance Analyst

Highmark Health; Springfield (IL); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. is seeking a quality improvement professional to work across compliance, process improvement, medical record review, and coding for all product lines.

The role focuses on improving documentation, applying ICD-10-CM coding, and supporting accreditation activities through audits and provider education. The position requires RN/LPN licensure or a healthcare-related degree, with substantial experience in HEDIS/HCC coding and process improvement.

Qualifications

• RN or LPN license or healthcare-related bachelor’s degree
• 6 years of experience in HEDIS/Quality abstraction or HCC coding in lieu of bachelor’s
• 3 years of nursing or healthcare-related field

Responsibilities

• Develop and manage process improvement initiatives using detailed data analysis, process analysis, report generation, medical record documentation, and HCC coding.

Skills

TQM concepts

Statistics analysis

Verbal communication

Written communication

MS Office

Analytical skills

Problem solving

Healthcare data

Education

RN or LPN license or healthcare-related bachelor’s degree

Substitution: 6 years of experience in lieu of bachelor’s

Tools

Microsoft Office

Job description

Highmark Inc. is seeking a quality improvement professional to work across compliance, process improvement, medical record review, and coding for all product lines.

The role focuses on improving documentation, applying ICD-10-CM coding, and supporting accreditation activities through audits and provider education. The position requires RN/LPN licensure or a healthcare-related degree, with substantial experience in HEDIS/HCC coding and process improvement.