Clinical Quality & Compliance Improvement Analyst

Highmark Health

Virginia

Remote

USD 63,000 - 97,000

Full time

7 days ago

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Job summary

Highmark Inc. is seeking a healthcare quality and coding professional to support compliance, process improvement, and documentation accuracy across product lines. The role emphasizes ICD-10-CM coding and provider education to improve STARS and value-based care results.

Responsibilities include data analysis, audits, and collaboration with credentialing and quality programs. Requires RN/LPN or healthcare-related degree with relevant coding experience; strong communication and MS Office skills are

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.
CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire.

Responsibilities

Develop and manage process improvement initiatives with data analysis and reporting.
Analyze information from office site/medical record reviews to improve care and coding.
Monitor regulatory/accrediting requirements and adjust the compliance plan.
Conduct audits and educate providers on STARS, HEDIS, and HCC Coding; re-audit as needed.
Other duties as assigned or requested.