Clinical Quality & Compliance Analyst – HEDIS/HCC

Highmark Health; Montana; À distance; USD 63 000 - 97 000; Plein temps

Résumé du poste

Highmark Inc. seeks a healthcare quality professional to lead process improvements across compliance, coding, and documentation. You will analyze data, conduct medical record reviews, and ensure accurate ICD-10-CM coding for better STARS and value-based outcomes.

The role requires RN/LPN or healthcare degree, and CPC/CRC/RHIA/RHIT/CCS credentials or progress toward them. Travel 0–25% with office-based duties and HIPAA compliance mentoring.

Qualifications

• RN or LPN license or Bachelor's degree in a Healthcare-related field.
• CPC, CRC, RHIA, RHIT or CCS certification or ability to obtain within 4 months.
• 3 years of nursing or healthcare-related experience; project management and Medicaid/Medicare exp are a plus.

Responsabilités

• Develop and manage process improvement initiatives with data analysis and reporting.
• Conduct medical record reviews and coding to improve documentation and STARS/HEDIS/HCC outcomes.
• Ensure compliance with CMS/NQCA guidelines and participate in audits and education for providers.

Connaissances

TQM concepts

Statistics

Verbal communication

Written communication

Analytical thinking

Formation

RN or LPN license or Bachelor's in healthcare

CPC, CRC, RHIA, RHIT, or CCS Certification

Outils

Microsoft Office

Description du poste

Highmark Inc. seeks a healthcare quality professional to lead process improvements across compliance, coding, and documentation. You will analyze data, conduct medical record reviews, and ensure accurate ICD-10-CM coding for better STARS and value-based outcomes.

The role requires RN/LPN or healthcare degree, and CPC/CRC/RHIA/RHIT/CCS credentials or progress toward them. Travel 0–25% with office-based duties and HIPAA compliance mentoring.