Remote Clinical Quality & Coding Improvement Analyst

Highmark Health / AHN; United States; Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. seeks a health quality professional to drive process improvements across compliance, coding, and medical record reviews. You will enhance documentation, ensure ICD-10-CM coding accuracy, and support STARs and HEDIS programs.

You will educate providers and staff on CMS/NCQA standards, perform audits, and coordinate credentialing activities while collaborating with multiple departments to improve overall care quality.

Qualifications

• Current state RN or LPN license or healthcare-related bachelor's degree.
• Experience with HEDIS/quality abstraction or HCC coding is preferred.
• Knowledge of CMS/NCQA standards and quality improvement principles.

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting.
• Conduct audits and reviews to improve documentation and ICD-10-CM coding.
• Educate providers and staff on documentation, coding, and STARS/HEDIS requirements.
• Coordinate credentialing, credentialing reviews, and related quality activities.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Education

RN/LPN license or healthcare bachelor's

eNLC multi-state licensure (optional)

Tools

MS Office

Coding/Medical coding systems

Job description

Highmark Inc. seeks a health quality professional to drive process improvements across compliance, coding, and medical record reviews. You will enhance documentation, ensure ICD-10-CM coding accuracy, and support STARs and HEDIS programs.

You will educate providers and staff on CMS/NCQA standards, perform audits, and coordinate credentialing activities while collaborating with multiple departments to improve overall care quality.