Healthcare Quality & Compliance Analyst — HEDIS & HCC

Highmark Health; Denver (CO); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health seeks an experienced professional to advance compliance and process-improvement initiatives across multiple product lines. You will coordinate medical record reviews, coding accuracy, and documentation improvement to support CMS, NCQA, and STARS performance.

The role requires RN/LPN license or healthcare bachelor’s degree, with experience in HEDIS, HCC coding, and audits. Travel is possible, and office-based work is expected.

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/medical coding, or healthcare related field in lieu of bachelor's degree
• 3 years of nursing or healthcare-related field

Responsibilities

• Develop and manage process-improvement initiatives related to member and provider care, data analysis, and coding.
• Conduct data collection and analysis from medical records reviews to improve documentation and coding.
• Monitor regulatory/accrediting changes and adjust the compliance plan accordingly.
• Conduct audits (retrospective, concurrent, prospective) and educate providers on STARS, HEDIS, and HCC coding.

Skills

TQM concepts

Statistics

Verbal & written communication

MS Office proficiency

Analytical thinking

Education

RN or LPN license

Bachelor’s degree in healthcare-related field

CPC/CRC/RHIA/RHIT/CCS certification or eligible

Tools

MS Office

EHR systems

Job description

Highmark Health seeks an experienced professional to advance compliance and process-improvement initiatives across multiple product lines. You will coordinate medical record reviews, coding accuracy, and documentation improvement to support CMS, NCQA, and STARS performance.

The role requires RN/LPN license or healthcare bachelor’s degree, with experience in HEDIS, HCC coding, and audits. Travel is possible, and office-based work is expected.