Clinical Quality & HEDIS RN Analyst

Highmark Health; Lansing (MI); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. in Michigan is seeking a Health Quality Analyst to partner with compliance, process improvement, medical record review and coding to enhance documentation and ICD-10-CM coding for all product lines.

You will support STARS, HEDIS, and CMS/NCQA guidelines while educating providers and office staff on documentation improvements. Responsibilities include data analysis, audits, credentialing coordination, and ongoing process enhancements to improve care quality and member satisfaction

Qualifications

• Current state RN or LPN license or Bachelor's degree in a Healthcare-related field.
• 3 years of nursing or healthcare-related field experience.
• CPC, CRC, RHIA, RHIT, or CCS certification or must obtain within 4 months of hire.

Responsibilities

• Develop and manage process improvement initiatives with data analysis, process analysis, report generation, and HCC Coding.
• Conduct audits and site visits, identify gaps, and communicate results; educate providers on STARS and HEDIS.
• Monitor regulatory requirements and adjust the compliance plan to CMS Coding Guidelines.
• Coordinate credentialing activities and support quality improvement programs.

Skills

TQM concepts

Statistics

Communication skills

Microsoft Office

Analytical skills

Education

RN/LPN license or Bachelor's

Tools

Microsoft Office Suite

Job description

Highmark Inc. in Michigan is seeking a Health Quality Analyst to partner with compliance, process improvement, medical record review and coding to enhance documentation and ICD-10-CM coding for all product lines.

You will support STARS, HEDIS, and CMS/NCQA guidelines while educating providers and office staff on documentation improvements. Responsibilities include data analysis, audits, credentialing coordination, and ongoing process enhancements to improve care quality and member satisfaction