Quality & Coding Analyst - HEDIS/HCC Focus

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

Job summary

Highmark Health is seeking a Compliance and Quality Improvement professional to lead process improvement initiatives across compliance, coding, and medical record review. You will analyze data, support ICD10-CM coding accuracy, and drive quality initiatives with provider education and audits.

The role requires RN/LPN license or healthcare-related degree with 3+ years in nursing or related field, plus project management or Medicaid/Medicare experience is a plus.

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
• RN with an active compact license is preferred

Responsibilities

• Develop and manage process improvement initiatives with data analysis, reporting, documentation, and coding.
• Conduct data collection and analysis from site visits and medical record reviews to improve care and coding for members.
• Adjust compliance plans based on CMS Coding Guidelines and regulatory changes.
• Conduct audits (retrospective, concurrent, semi-annual, annual) and communicate gaps.
• Provide continuing education to providers on STARS, HEDIS, and HCC Coding.
• Coordinate credentialing/recertification and other reviews as requested.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

Professional writing

Communication with medical admins

Computer literacy

MS Office

Analytical/problem solving

Education

RN/LPN license or Healthcare degree

Tools

Microsoft Office Suite

Job description

Highmark Health is seeking a Compliance and Quality Improvement professional to lead process improvement initiatives across compliance, coding, and medical record review. You will analyze data, support ICD10-CM coding accuracy, and drive quality initiatives with provider education and audits.

The role requires RN/LPN license or healthcare-related degree with 3+ years in nursing or related field, plus project management or Medicaid/Medicare experience is a plus.