Kimberly Hightower

Background

About Kimberly Hightower

Results-driven Healthcare Compliance & Data Integrity Specialist with over a decade of experience in HEDIS, risk adjustment, healthcare analytics, and regulatory compliance (NCQA, CMS, HIPAA). I specialize in ensuring healthcare data accuracy, mitigating compliance risks, conducting audits, and optimizing quality reporting to support enterprise-wide regulatory adherence and performance improvement. My expertise includes: HEDIS & Quality Compliance Audits (Medical Record Review, Data Abstraction) Regulatory Compliance, Risk Management & Auditing (NCQA, CMS, HIPAA, OIG) Healthcare Data Integrity & Governance (MPI, Claims Validation, Provider Data Management) Risk Adjustment Audits & Claims Analysis (Medicare Advantage, Medicaid, RAF Scoring) Electronic Health Records (EHR), Data Validation & Interoperability Compliance Healthcare Data Audits, Process Optimization & Performance Improvement I am passionate about leveraging healthcare data to enhance compliance, improve patient outcomes, and support regulatory adherence. My ability to conduct detailed audits, identify risks, streamline reporting, and drive process improvements ensures organizations achieve quality and compliance goals efficiently. Let’s connect! I actively engage in healthcare compliance, quality assurance, and risk management communities. I welcome discussions on health data governance, regulatory compliance, and healthcare quality improvement.