Remote Clinical Quality & Compliance Analyst

Highmark Health; Muncie (IN); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. seeks a compliance and quality improvement professional to partner with departments across the organization. You will support medical record review, ICD-10-CM coding, and provider education to enhance member care and documentation.

The role involves audits, data analysis, and ongoing improvement initiatives to meet CMS and NCQA standards, with remote work options and potential site visits as needed.

Qualifications

• Current state RN or LPN license or Bachelor's degree in a Healthcare-related field.
• 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare related field in lieu of bachelor's degree.
• 3 years of nursing or healthcare-related field.
• Current State RN or LPN licensure OR eNLC/CPC/CRC/RHIA/RHIT/CCS certification within 4 months of hire.
• Strong written and verbal communication; ability to work with medical administrators and physicians.

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting.
• Analyze office site and medical record data to improve documentation and coding.
• Monitor regulatory and accrediting requirements and update compliance plans.
• Conduct audits (retrospective, concurrent, prospective) and provide provider education on STARS, HEDIS, HCC Coding.
• Perform additional duties as assigned.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical skills

Education

RN/LPN license or Healthcare Bachelor's

Tools

Microsoft Office Suite

Job description

Highmark Inc. seeks a compliance and quality improvement professional to partner with departments across the organization. You will support medical record review, ICD-10-CM coding, and provider education to enhance member care and documentation.

The role involves audits, data analysis, and ongoing improvement initiatives to meet CMS and NCQA standards, with remote work options and potential site visits as needed.