Quality Improvement Analyst - HEDIS & Coding

Highmark Health

Town of King (WI)

Remote

USD 63,000 - 97,000

Full time

6 days ago

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Job summary

Highmark Health is seeking a compliance and quality improvement professional to support medical record review, coding accuracy, and process improvement across product lines. The role involves educating providers on CMS/NCQA standards and driving STARS and value-based care initiatives.

Responsibilities include conducting audits, data analysis, credentialing coordination, and ensuring adherence to HIPAA and privacy policies while improving documentation and ICD-10-CM coding to support better

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 experience

Responsibilities

Develop and manage process improvement initiatives from the Organization for member and providers to include detailed data analysis, process analysis, report generation, medical record documentation, and HCC Coding.
Conduct, collect and analyze information and data from office site and/or medical record reviews to improve care, services, documentation and coding for members, to properly assign ICD10-CM codes.
Conduct retrospective, concurrent, and prospective audits, identify gaps and communicate results.