RN Clinical Quality & Process Improvement Analyst

Highmark Health; Boise (ID); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. seeks a healthcare quality professional to drive process improvement, data analysis, and accurate ICD-10-CM coding across multiple programs.

You will educate providers, perform audits, and support credentialing and accreditation activities to enhance STARs and value-based care outcomes. The role requires an RN/LPN license or healthcare degree with 3+ years of nursing/healthcare experience and knowledge of CMS/HEDIS guidelines.

Qualifications

• Knowledge of TQM and quality improvement methods.
• Ability to analyze data and improve documentation and coding.
• Experience with CMS/HEDIS/HCC coding and STARs initiatives.

Responsibilities

• Develop and manage process-improvement initiatives with data analysis and reporting.
• Review medical records to assign ICD-10-CM codes and improve documentation.
• Educate providers on STARS, HEDIS, and HCC coding; conduct audits and re-audits.
• Coordinate credentialing, investigations, and other quality activities as needed.
• Monitor regulatory changes and update the compliance plan accordingly.

Skills

TQM concepts

Statistics

Verbal and written communication

MS Office

Analytical thinking

Education

RN or LPN license or Bachelor's in a healthcare-related field

6 years of experience in HEDIS/Quality abstraction, HCC coding or related field

Job description

Highmark Inc. seeks a healthcare quality professional to drive process improvement, data analysis, and accurate ICD-10-CM coding across multiple programs.

You will educate providers, perform audits, and support credentialing and accreditation activities to enhance STARs and value-based care outcomes. The role requires an RN/LPN license or healthcare degree with 3+ years of nursing/healthcare experience and knowledge of CMS/HEDIS guidelines.