RN Clinical Quality & Data Analyst

Highmark Health; Juneau (AK); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. seeks a healthcare quality and compliance professional to improve documentation and ICD-10-CM coding across product lines.

You will lead process-improvement initiatives, conduct medical record reviews, and educate providers on CMS and NCQA standards to optimize STARS and value-based care. The role requires RN or LPN licensure or a healthcare Bachelor's degree, with 3 years in nursing or healthcare, plus experience in HEDIS/HCC coding.

Qualifications

• Current RN or LPN license or Bachelor’s degree in a Healthcare-related field.
• 6 years of experience with HEDIS/Quality abstraction, HCC Coding or healthcare field in lieu of degree.
• 3 years of nursing or healthcare-related field.

Responsibilities

• Develop and manage process-improvement initiatives with data analysis, process analysis, report generation, medical record documentation, and HCC coding.
• Conduct/collect/analyze information from audits to improve care, documentation and coding for members; coordinate with revenue, credentialing and quality programs to improve STARS and value-based care.
• Monitor regulatory/accrediting requirements and adjust the compliance plan to CMS guidelines.
• Conduct audits (retrospective, concurrent, prospective) and provider education on STARS, HEDIS and HCC coding; perform re-audits as needed.
• Other duties as assigned or requested.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

Microsoft Office

Analytical skills

Education

RN/LPN license or healthcare-related Bachelor’s degree

Tools

Microsoft Office

Job description

Highmark Inc. seeks a healthcare quality and compliance professional to improve documentation and ICD-10-CM coding across product lines.

You will lead process-improvement initiatives, conduct medical record reviews, and educate providers on CMS and NCQA standards to optimize STARS and value-based care. The role requires RN or LPN licensure or a healthcare Bachelor's degree, with 3 years in nursing or healthcare, plus experience in HEDIS/HCC coding.