RN Quality Improvement Analyst — Medical Records & Coding

Highmark Health; Helena (MT); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. is seeking a healthcare quality/improvement professional to collaborate with compliance, coding, and care-quality teams. The role focuses on improving documentation, ICD-10-CM coding accuracy, and provider education across product lines.

You will coordinate reviews and audits, support credentialing activities, and help advance STARs and value-based care initiatives within the organization.

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
• CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire
• Experience with managed care organizations and accreditation programs is a plus.

Responsibilities

• Develop and manage process improvement initiatives with data analysis, reporting, and documentation.
• Conduct and analyze information from audits and reviews to improve care and documentation for proper coding.
• Monitor regulatory/accrediting changes and adjust the compliance plan to CMS guidelines.
• Perform audits (retrospective, concurrent, prospective) and provide continuing education to providers.
• Coordinate credentialing/recertification and respond to member/provider inquiries when needed.

Skills

TQM concepts

Statistics

Communication

Computer literacy

Analytical thinking

Education

RN/LPN license or healthcare bachelor's

HEDIS/Quality abstraction or HCC coding experience

CPC/CRC/RHIA/RHIT/CCS certification or interim within 4 months

MS Office proficiency

Tools

MS Office (Word, Excel)

Job description

Highmark Inc. is seeking a healthcare quality/improvement professional to collaborate with compliance, coding, and care-quality teams. The role focuses on improving documentation, ICD-10-CM coding accuracy, and provider education across product lines.

You will coordinate reviews and audits, support credentialing activities, and help advance STARs and value-based care initiatives within the organization.