Clinical Quality Improvement Analyst

Highmark Health; Tallahassee (FL); Remote; USD 63.000 - 97.000; Vollzeit

Zusammenfassung

Highmark Inc. is seeking a compliance-focused professional to improve documentation, coding accuracy, and overall quality across product lines. You will lead education for providers and staff on CMS, NCQA standards, and STARS initiatives.

The role requires RN/LPN licensure or a healthcare degree, plus experience in HEDIS/HCC coding and quality abstraction. Expect office-based work with travel as needed and an emphasis on process improvement and audits.

Qualifikationen

• 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.

Aufgaben

• Develop and manage process improvement initiatives with data analysis and reporting.
• Analyze information from reviews to improve care, services, and proper documentation.
• Monitor regulatory/accrediting requirements and adjust the compliance plan.

Kenntnisse

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Data analysis

Ausbildung

RN or LPN license OR Bachelor's in healthcare

6 years experience in HEDIS/Quality abstraction or HCC coding

Tools

Microsoft Office (Word, Excel, Access, PowerPoint)

Jobbeschreibung

Highmark Inc. is seeking a compliance-focused professional to improve documentation, coding accuracy, and overall quality across product lines. You will lead education for providers and staff on CMS, NCQA standards, and STARS initiatives.

The role requires RN/LPN licensure or a healthcare degree, plus experience in HEDIS/HCC coding and quality abstraction. Expect office-based work with travel as needed and an emphasis on process improvement and audits.