Clinical Quality Improvement & Coding Analyst

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

Job summary

Highmark Health is seeking a knowledgeable professional to lead process improvement efforts across compliance, coding, and quality initiatives for member care. You will analyze medical records, coordinate audits, and support credentialing activities to enhance documentation and ICD-10-CM coding accuracy.

Responsible for educating providers on STARS, HEDIS, and HCC coding, you will work with multiple departments to ensure regulatory alignment and continuous quality improvement.

Qualifications

• RN or LPN licensure or Bachelor’s degree in a healthcare-related field is required.
• Substitutions allow 6 years of related healthcare experience in lieu of degree.

Responsibilities

• Develop and manage process improvement initiatives with data analysis, reporting, and documentation.
• Perform audits, site visits, and medical record reviews to improve care, documentation, and coding.
• Educate providers on STARS, HEDIS, and HCC Coding; coordinate credentialing activities as needed.

Skills

TQM concepts

Statistics

Verbal & written communication

Microsoft Office

Education

RN or LPN licensure or Bachelor's degree in Healthcare

Tools

Microsoft Office

Job description

Highmark Health is seeking a knowledgeable professional to lead process improvement efforts across compliance, coding, and quality initiatives for member care. You will analyze medical records, coordinate audits, and support credentialing activities to enhance documentation and ICD-10-CM coding accuracy.

Responsible for educating providers on STARS, HEDIS, and HCC coding, you will work with multiple departments to ensure regulatory alignment and continuous quality improvement.