Healthcare Quality & Compliance Analyst – HEDIS/HCC Coding

Highmark Health

Rhode Island

Remote

USD 63,000 - 97,000

Full time

6 days ago

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Job summary

Highmark Health seeks a healthcare quality and compliance professional to work across departments, focusing on compliance, process improvement, medical record review, coding, and provider education. The role aims to improve documentation and ICD-10-CM coding accuracy while supporting STAR and value-based care initiatives.

Candidates should have a nursing license or healthcare degree, plus HEDIS/HCC experience; certification in CPC/CRC/RHIA/RHIT/CCS is preferred or must be obtained within 4

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.
CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire.

Responsibilities

Develop and manage process improvement initiatives with data analysis and reporting.
Analyze information from office site and medical record reviews to improve care and documentation.
Monitor CMS guidelines and adjust the compliance plan accordingly.
Conduct audits (retrospective, concurrent, prospective) and communicate results to providers.
Train providers on STARS, HEDIS, and HCC coding; perform re-audits as needed.

Skills

TQM concepts

Statistics

Communication skills

Microsoft Office

Analytical thinking

Education

RN/LPN license or healthcare degree

CPC/CRC/RHIA/RHIT/CCS certification

Job description

Candidates should have a nursing license or healthcare degree, plus HEDIS/HCC experience; certification in CPC/CRC/RHIA/RHIT/CCS is preferred or must be obtained within 4

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