RN Clinical Quality & Coding Analyst — Process Improvement

Highmark Health; Salem (OR); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. seeks a quality and coding professional to partner with compliance, process improvement, medical record review, and coding across product lines. You will drive ICD-10-CM coding accuracy and support STARS initiatives while educating providers on regulatory requirements.

This role includes audits, data analysis, provider education, and collaboration with credentialing and quality teams to enhance care quality and documentation standards.

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

Responsibilities

• Develop and manage process improvement initiatives with data analysis, process analysis, report generation, medical record documentation, and HCC Coding.
• Conduct information and data from office site/medical record reviews to improve care, documentation, and coding for members; coordinate with revenue programs, credentialing and quality improvement.

Skills

TQM concepts

Statistics

Verbal & written communication

Computer literacy

Analytical problem-solving

Education

RN/LPN license or healthcare bachelor's

Job description

Highmark Inc. seeks a quality and coding professional to partner with compliance, process improvement, medical record review, and coding across product lines. You will drive ICD-10-CM coding accuracy and support STARS initiatives while educating providers on regulatory requirements.

This role includes audits, data analysis, provider education, and collaboration with credentialing and quality teams to enhance care quality and documentation standards.