Clinical Quality Improvement Analyst

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

Job summary

Highmark Health is seeking a quality improvement professional to partner with compliance, process improvement, and medical record review teams. This role focuses on improving documentation, coding accuracy (ICD10-CM), and STARS/HEDIS outcomes across product lines.

The incumbent will lead audits, provide education, and coordinate credentialing-related activities. Ideal candidates possess RN/LPN or healthcare degree, with HEDIS/HCC coding experience; strong analytical and communication 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

Responsibilities

• Develop and manage process improvement initiatives with data analysis, process analysis, report generation, medical record documentation, and HCC Coding.
• Conduct, collect and analyze information and data from office site and/or medical record reviews to continually improve care, documentation and coding for members.
• Conduct continuing education to providers on STARS, HEDIS, and HCC Coding.
• Conduct retrospective, concurrent, and prospective audits, identify gaps and communicate results.
• Other duties as assigned or requested.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical problem solving

Medical record documentation

Education

RN or LPN license or Bachelor's degree in healthcare

Job description

Highmark Health is seeking a quality improvement professional to partner with compliance, process improvement, and medical record review teams. This role focuses on improving documentation, coding accuracy (ICD10-CM), and STARS/HEDIS outcomes across product lines.

The incumbent will lead audits, provide education, and coordinate credentialing-related activities. Ideal candidates possess RN/LPN or healthcare degree, with HEDIS/HCC coding experience; strong analytical and communication skills are