Quality Improvement RN Analyst — HEDIS & Coding

Highmark Health; Trenton (NJ); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health in New Jersey seeks a Compliance and Quality Assurance professional to drive process improvements across medical record review, coding accuracy and STARS performance. The role collaborates with compliance, clinical operations and credentialing to enhance documentation and regulatory adherence.

Focusing on HCC coding, CMS/NCQA standards and continuous quality improvement, you will plan audits, deliver education to providers, and support accreditation efforts while aligning with

Qualifications

• 3 years of nursing or healthcare-related field
• Current state RN or LPN licensure OR current multi-state licensure through eNLC
• Certification: CPC, CRC, RHIA, RHIT, or CCS or must obtain within 4 months

Responsibilities

• Develop and manage process improvement initiatives with data analysis, reporting and coding accuracy
• Conduct information and data collection from site and records to improve documentation and coding
• Monitor regulatory requirements and adjust the compliance plan per CMS guidelines
• Conduct audits (retrospective, concurrent, annual) and educate providers on STARS, HEDIS and HCC coding
• Other duties as assigned

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical thinking

Problem-solving

Education

RN or LPN license or Healthcare Bachelor's

Tools

Microsoft Office

Job description

Highmark Health in New Jersey seeks a Compliance and Quality Assurance professional to drive process improvements across medical record review, coding accuracy and STARS performance. The role collaborates with compliance, clinical operations and credentialing to enhance documentation and regulatory adherence.

Focusing on HCC coding, CMS/NCQA standards and continuous quality improvement, you will plan audits, deliver education to providers, and support accreditation efforts while aligning with