Quality Improvement & Compliance Analyst

Highmark Health; Bismarck (ND); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health is seeking a quality and compliance professional to drive process improvements, audit medical records, and educate providers on HEDIS, STARS, and HCC coding. This role collaborates with compliance, coding, and audit teams to enhance documentation and coding accuracy.

You will coordinate credentialing activities, conduct site visits, and support initiatives to improve care quality and value-based outcomes.

Qualifications

• Current state RN or LPN license or Bachelor's degree in a healthcare-related field
• 6 years of HEDIS/Quality abstraction or HCC coding experience in lieu of a bachelor's degree
• 3 years of nursing or healthcare-related experience
• 1 year of Medicaid/Medicare or Managed Care experience (preferred)

Responsibilities

• Develop and manage process improvement initiatives with detailed data analysis, process analysis, report generation, and coding
• Conduct office site and medical record reviews to improve care, documentation, and ICD-10-CM coding
• Coordinate credentialing, re-credentialing, member complaint investigations, and quality activities
• Conduct continuing education for providers on STARS, HEDIS, and HCC coding
• Perform audits and communicate results; handle other duties as assigned

Skills

Total Quality Management

Statistics

Verbal communication

Written communication

Provider communications

Microsoft Office

Analytical skills

Travel 0-25%

Education

RN or LPN license or healthcare bachelor’s

HEDIS/Quality abstraction experience (6+ years) or HCC coding

1 year PM/managed care experience (preferred)

Tools

Microsoft Office

Job description

Highmark Health is seeking a quality and compliance professional to drive process improvements, audit medical records, and educate providers on HEDIS, STARS, and HCC coding. This role collaborates with compliance, coding, and audit teams to enhance documentation and coding accuracy.

You will coordinate credentialing activities, conduct site visits, and support initiatives to improve care quality and value-based outcomes.