Quality Improvement & Compliance Analyst

Highmark Health; Alton (IL); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health seeks a quality improvement professional to collaborate with compliance, process improvement, medical record review and coding, and satisfaction across all product lines. You will recommend and implement process improvements to ensure high-quality care and proper ICD10-CM documentation.

This role trains providers on STARS, HEDIS, and HCC coding, conducts audits/site visits, and coordinates credentialing activities.

Qualifications

• 3 years of nursing or healthcare-related field.
• RN or LPN license or healthcare degree required.
• 6 years of experience in lieu of degree in HEDIS/Quality abstraction or related field.
• CPC/CRC/RHIA/RHIT/CCS certifications or eligible within 4 months of hire.

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting.
• Conduct medical record reviews and coding to improve STARS and value-based care.
• Educate providers on STARS, HEDIS, and HCC coding.
• Perform audits and re-audits as needed.
• Coordinate credentialing activities and related reviews.

Skills

TQM concepts

Statistics understanding

Verbal communication

Written communication

MS Office

Analytical reasoning

Education

RN/LPN license or healthcare degree

Tools

Electronic medical records systems

Job description

Highmark Health seeks a quality improvement professional to collaborate with compliance, process improvement, medical record review and coding, and satisfaction across all product lines. You will recommend and implement process improvements to ensure high-quality care and proper ICD10-CM documentation.

This role trains providers on STARS, HEDIS, and HCC coding, conducts audits/site visits, and coordinates credentialing activities.