Quality Improvement & Compliance Analyst

Highmark Health; Eagle (ID); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. is seeking a quality improvement professional to collaborate with compliance, coding, and provider relations to enhance documentation and ICD-10-CM coding across product lines.

The role involves leading audits, education on STARS/HEDIS/HCC coding, and driving process improvements with cross-functional teams to ensure timely, accurate outcomes and accreditation readiness.

Qualifications

• Experience with HEDIS/Quality abstraction and coding.
• Knowledge of ICD-10-CM coding and documentation standards.
• Strong data analysis and process improvement skills.

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting.
• Conduct medical record reviews to improve documentation and coding for members.
• Monitor regulatory/accreditation requirements and update compliance plans.
• Conduct audits and education on STARS, HEDIS, and HCC Coding.
• Coordinate credentialing activities and other reviews as requested.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Education

RN or LPN license or Bachelors in healthcare

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

Tools

Microsoft Office

Job description

Highmark Inc. is seeking a quality improvement professional to collaborate with compliance, coding, and provider relations to enhance documentation and ICD-10-CM coding across product lines.

The role involves leading audits, education on STARS/HEDIS/HCC coding, and driving process improvements with cross-functional teams to ensure timely, accurate outcomes and accreditation readiness.