Quality Improvement & Coding Analyst (HEDIS/STARS)

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

Job summary

Highmark Health is seeking a Quality Improvement professional to collaborate with compliance, process improvement, medical record review and coding teams. You will analyze data, conduct audits, and educate providers on CMS/NCQA standards to improve STARS and value-based care.

Required: RN/LPN license or healthcare-related bachelor’s, 3+ years in nursing or healthcare, and knowledge of HEDIS/HCC coding. Travel 0–25% possible.

Qualifications

• Current state RN or LPN license or Bachelor's degree in a healthcare-related field.
• Substitutions: 6 years of experience with 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 ensure proper documentation and coding.
• Educate providers on STARS, HEDIS, and HCC coding to drive quality improvement.
• Perform audits and coordinate credentialing activities as needed.

Education

RN or LPN license or Bachelor's in healthcare

6 years HEDIS/Quality abstraction or HCC coding

Healthcare field experience 6+ years (in lieu of degree)

Tools

Microsoft Office

Excel

Information systems

Job description

Highmark Health is seeking a Quality Improvement professional to collaborate with compliance, process improvement, medical record review and coding teams. You will analyze data, conduct audits, and educate providers on CMS/NCQA standards to improve STARS and value-based care.

Required: RN/LPN license or healthcare-related bachelor’s, 3+ years in nursing or healthcare, and knowledge of HEDIS/HCC coding. Travel 0–25% possible.