Clinical Quality & Process Improvement Analyst

Highmark Health

Columbia (SC)

Remote

USD 63,000 - 97,000

Full time

6 days ago

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Job summary

Highmark Inc. is seeking a healthcare quality/procurement professional to advance process improvements across compliance, coding, and member/provider satisfaction.

You will lead data-driven audits, support HCC coding, and coordinate credentialing and quality initiatives to meet CMS/NCQA standards. The role requires RN/LPN or healthcare degree, 3 years in nursing/healthcare, and relevant certifications with education on STARS and HEDIS.

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 or healthcare field in lieu of bachelor.
CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire.
3 years of nursing or healthcare-related field.

Responsibilities

Develop and manage process improvement initiatives with data analysis and reporting.
Conduct information and data collection from office/site reviews to improve care and coding.
Monitor regulatory/accreditation changes and adjust the compliance plan.
Conduct audits (retrospective, concurrent, prospective) and communicate results.
Provide continuing education to providers on STARS, HEDIS, and HCC Coding.
Perform re-audits as needed.
Other duties as assigned.

Skills

TQM concepts

Statistics

Verbal & written communication

MS Office familiarity

Analytical problem solving

Education

RN or LPN license or healthcare degree

Bachelor's degree in healthcare-related field

Job description

Highmark Inc. is seeking a healthcare quality/procurement professional to advance process improvements across compliance, coding, and member/provider satisfaction.

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