Clinical Quality & Performance Analyst

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

Job summary

Highmark Health in Idaho seeks an experienced Quality Improvement professional with nursing licensure and 3+ years in healthcare to lead process improvements, drive documentation accuracy, and support STARS/HEDIS programs. The role requires auditing, education of providers, and collaboration with compliance and revenue teams.

Responsibilities include data analysis, coding accuracy, and regulatory alignment to enhance member and provider satisfaction across product lines. Travel may be required.

Qualifications

• Current state RN or LPN license or Bachelor’s degree in a Healthcare-related field
• 3 years of nursing or healthcare-related experience
• CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire
• 6 years of experience with HEDIS/Quality abstraction, HCC Coding, or healthcare field in lieu of bachelor’s degree
• Preferred: Medicaid/Medicare experience and MCO familiarity

Responsibilities

• Develop and manage process improvement initiatives with data analysis, process analysis, report generation, and coding.
• Conduct information and data collection from office sites and medical record reviews to improve care, documentation, and coding.
• Monitor regulatory/accrediting requirements and adjust compliance plans accordingly.
• Conduct various audits (retrospective, concurrent, prospective) and communicate results; provide continuing education to providers on STARS, HEDIS, and HCC coding.

Skills

TQM concepts

Statistics

Verbal & written communication

MS Office proficiency

Analytical problem-solving

Education

RN/LPN license or healthcare bachelor

6 years HEDIS/Quality abstraction or HCC coding in lieu of degree

Tools

Microsoft Office Suite

Job description

Highmark Health in Idaho seeks an experienced Quality Improvement professional with nursing licensure and 3+ years in healthcare to lead process improvements, drive documentation accuracy, and support STARS/HEDIS programs. The role requires auditing, education of providers, and collaboration with compliance and revenue teams.

Responsibilities include data analysis, coding accuracy, and regulatory alignment to enhance member and provider satisfaction across product lines. Travel may be required.