Quality & Compliance RN Analyst — HEDIS & Coding

Highmark Health; Phoenix (AZ); Remote; USD 63,000 - 97,000; Full time

Benefits offered by this job

None

Job summary

Highmark Inc. is seeking a qualified healthcare professional to support compliance, process improvement, and accurate ICD10-CM coding across product lines. You will analyze data, improve documentation, and educate providers on CMS and NCQA standards to enhance member care and STARS performance.

The role requires nursing credentials (RN/LPN) or a healthcare-related bachelor's degree, plus experience in HEDIS/HCC coding and Medicaid/Medicare environments. Travel and site visits may be involved.

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

Responsibilities

• Develop and manage process improvement initiatives with data analysis, process analysis, and reporting
• Conduct audits and education to providers on STARS, HEDIS, and HCC Coding
• Coordinate credentialing and audits to improve documentation and coding

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical skills

Education

RN/LPN license or Bachelor's in healthcare

Tools

CPC/CRC/RHIA/RHIT/CCS Certification

Job description

Highmark Inc. is seeking a qualified healthcare professional to support compliance, process improvement, and accurate ICD10-CM coding across product lines. You will analyze data, improve documentation, and educate providers on CMS and NCQA standards to enhance member care and STARS performance.

The role requires nursing credentials (RN/LPN) or a healthcare-related bachelor's degree, plus experience in HEDIS/HCC coding and Medicaid/Medicare environments. Travel and site visits may be involved.