Healthcare Quality Improvement & Coding Analyst

Highmark Health; Massachusetts; Hybrid; USD 63,000 - 97,000; Full time

Job summary

Highmark Health seeks a detail-oriented professional to drive quality improvements in compliance, documentation, and coding across products. You will analyze data, perform audits, and educate staff to improve CMS/NCQA alignment and STARS performance.

Responsibilities include coordinating credentialing activities, site visits, and provider education, with an emphasis on accurate medical record documentation and coding for appropriate reimbursement.

Qualifications

• Current state RN or LPN license or Bachelor’s degree in a healthcare-related field.
• Substitutions: 6 years of HEDIS/Quality abstraction, HCC Coding, or healthcare field in lieu of degree.
• RN with an active compact license is preferred.

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting.
• Conduct medical record reviews to assign ICD-10-CM codes for chronic conditions.
• Coordinate credentialing, audits, and reviews to improve STARs, value-based care, and accreditation.
• Educate providers and staff on documentation, coding, and compliance requirements.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Data analysis

Education

RN/LPN license or Bachelor’s in healthcare

Tools

HCC Coding systems

CMS/HEDIS guidelines

Job description

Highmark Health seeks a detail-oriented professional to drive quality improvements in compliance, documentation, and coding across products. You will analyze data, perform audits, and educate staff to improve CMS/NCQA alignment and STARS performance.

Responsibilities include coordinating credentialing activities, site visits, and provider education, with an emphasis on accurate medical record documentation and coding for appropriate reimbursement.