Clinical Quality & Compliance Analyst - HEDIS & Coding

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

Job summary

Highmark Health is seeking a Quality Improvement professional with healthcare coding and HEDIS/HCC experience to lead process improvements across compliance, documentation, and review activities.

The role focuses on accurate ICD-10-CM coding, STARS performance, provider education, and audits, coordinating with credentialing and quality programs to drive superior member outcomes and regulatory adherence.

Qualifications

• RN or LPN license or healthcare bachelor’s required.
• 3 years of nursing or healthcare-related field required.
• Licensure or certifications (eNLC, CPC, CRC, RHIA, RHIT, CCS) must be obtained within 4 months of hire.
• Knowledge of STARS, HEDIS and HCC Coding helpful.

Responsibilities

• Develop and manage process improvement initiatives with data analysis, reporting, and coding.
• Conduct and analyze medical record reviews to improve documentation and coding for members.
• Coordinate credentialing and quality improvement activities with related programs.
• Provide continuing education to providers on STARS, HEDIS, and HCC Coding.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Analytical skills

Education

RN or LPN license or healthcare-related bachelor's

Job description

Highmark Health is seeking a Quality Improvement professional with healthcare coding and HEDIS/HCC experience to lead process improvements across compliance, documentation, and review activities.

The role focuses on accurate ICD-10-CM coding, STARS performance, provider education, and audits, coordinating with credentialing and quality programs to drive superior member outcomes and regulatory adherence.