Clinical Quality Improvement & Coding Analyst

Highmark Health; Yuma (AZ); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health is seeking a quality and compliance professional to work with appropriate departments to enhance documentation and coding for ICD-10-CM coding and quality measures. You will lead process improvements and perform medical record reviews and audits to support STARS and HEDIS initiatives.

The role requires RN/LPN license or healthcare degree, with experience in HEDIS/HCC coding and a background in managed care or accreditation programs. Travel may be required for site visits.

Qualifications

• Current state RN or LPN license or Bachelor’s degree in a Healthcare-related field.
• Substitutions: 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare related field in lieu of bachelor's degree.
• Preferred: None.

Responsibilities

• Develop and manage process improvement initiatives for members and providers, including detailed data analysis and reporting.
• Improve documentation and coding to support STARS, HEDIS, and quality improvements.
• Conduct audits and site visits; coordinate credentialing and reviews.
• Educate providers on guidelines and perform re-audits as needed.

Skills

TQM concepts

Statistics knowledge

Verbal communication

Written communication

Microsoft Office

Data analysis

Problem solving

Education

Bachelor’s degree in healthcare-related field

Job description

Highmark Health is seeking a quality and compliance professional to work with appropriate departments to enhance documentation and coding for ICD-10-CM coding and quality measures. You will lead process improvements and perform medical record reviews and audits to support STARS and HEDIS initiatives.

The role requires RN/LPN license or healthcare degree, with experience in HEDIS/HCC coding and a background in managed care or accreditation programs. Travel may be required for site visits.