Quality Practice Advisor
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections where posting has real specific content. Must not repeat job title. Must not include Job ID etc. Must preserve all substantive info. Remove boilerplate like EEO etc. Also remove application instructions. Must not create sections with placeholder text.
We need to parse the posting.
Content:
Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT Candidates must reside in Texas, with preference given to those located in East Houston (including Channelview, Baytown, Pasadena, Deer Park, and surrounding communities). This hybrid role requires both local travel and remote duties. Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).Identifies specific practice needs where Centene can provide support.Develops, enhances and maintains provider clinical relationship across product lines.Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.Ability to travel up to 75% of time to provider offices.Performs other duties as assigned.Complies with all policies and standards.
Education/Experience: Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required Licenses/Certifications One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS Registered Health Information Technician (RHIT®): For positions aligned to a corporate line of business that report into and operate within a state specific health plan, state requirements apply For Superior HealthPlan: license/certification is preferred
Pay Range: $27.02 - $48.55 per hour
Then a paragraph about Centene mission etc. Then benefits: "Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules."
Then "Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility."
Then EEO boilerplate etc which we must remove.
We need sections: About the role (maybe from Position Purpose). Responsibilities (list of duties). Requirements (maybe education/experience, licenses/certifications, residency, work authorization, travel). Qualifications (maybe same as requirements? But we need to decide). Skills (maybe specific skills like HEDIS, coding, etc). Benefits (list). Pay (range). Schedule (maybe hybrid role requires both local travel and remote duties, ability to travel up to 75% of time). We need to avoid placeholder.
We must not repeat job title. Use for each section heading.
We need to use - for any list of duties/requirements/benefits. Use
for prose.
We must preserve all substantive info; do not invent or summarize away detail.
We must not include sections with filler like "commensurate with experience". Not relevant.
We must not create Pay/Schedule/Benefits sections unless posting actually states them. It does state Pay Range, benefits, schedule (hybrid role requires both local travel and remote duties, ability to travel up to 75% of time). So we can include those sections.
We need to decide which content goes where.
Let's extract:
About the role: Position Purpose paragraph.
Responsibilities: The bullet list of duties: "Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements." "Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure." "Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)." "Identifies specific practice needs where Centene can provide support." "Develops, enhances and maintains provider clinical relationship across product lines." "Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards." "Ability to travel up to 75% of time to provider offices." "Performs other duties as assigned." "Complies with all policies and standards." Also earlier responsibilities: "Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers." Those could also be responsibilities. We'll combine.
Requirements: Education/Experience: Bachelor's Degree or equivalent required; 3+ years in HEDIS record collection and risk adjustment (coding) required. Licenses/Certifications: list. Also Must be authorized to work in the U.S. without need for employment-based visa sponsorship now or in the future. Candidates must reside in Texas, with preference given to those located in East Houston (including Channelview, Baytown, Pasadena, Deer Park, and surrounding communities). This hybrid role requires both local travel and remote duties. Ability to travel up to 75% of time to provider offices. (Travel could be schedule but also requirement). We'll include in Requirements.
Qualifications: Might be overlapping; but we could treat Qualifications as the licenses/certifications and education/experience? However we already used those in Requirements. To avoid duplication, we could put Qualifications as "Preferred qualifications" maybe none. But we need to include a section only if posting has real specific content. The posting does not separate "Qualifications" vs "Requirements". It has Education/Experience and Licenses/Certifications. Could treat those as Qualifications. But we already used them in Requirements. Perhaps we can split: Requirements: work authorization, residency, travel. Qualifications: education, experience, licenses/certifications. Skills: maybe HEDIS measures, coding, documentation, data analysis, collaboration, relationship building, etc. But we need to avoid inventing. We can extract skills from responsibilities: HEDIS measures, medical record documentation, ICD-9/10 CPT coding, quality improvement interventions, audits, provider relations, data collection/trending, coaching, etc. Those are substantive.
We need to ensure we don't duplicate content across sections; but it's okay if some info appears in multiple sections? The instruction: "Preserve ALL substantive information; do NOT invent or summarize away detail." It doesn't forbid duplication, but better to avoid redundancy. However we need to follow the instruction to use sections only when posting has real specific content. We can allocate content accordingly.
Let's design:
About the role
Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.
Responsibilities
- Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
- Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
- Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
- Identifies specific practice needs where Centene can provide support.
- Develops, enhances and maintains provider clinical relationship across product lines.
- Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
- Ability to travel up to 75% of time to provider offices.
- Performs other duties as assigned.
- Complies with all policies and standards.
Requirements
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
- Candidates must reside in Texas, with preference given to those located in East Houston (including Channelview, Baytown, Pasadena, Deer Park, and surrounding communities).
- This hybrid role requires both local travel and remote duties.
Qualifications
- Bachelor's Degree or equivalent required.
- 3+ years in HEDIS record collection and risk adjustment (coding) required.
- One of the following licenses/certifications required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS; Registered Health Information Technician (RHIT®) preferred for Superior HealthPlan.
Skills
- HEDIS measures knowledge and application.
- Medical record documentation guidelines.
- ICD-9/10 CPT coding.
- Quality improvement interventions and audits.
- Data collection, summarization, trending and reporting.
- Provider coaching and gap closure strategies.
- Collaboration with Provider Relations and cross‑functional teams.
- Provider relationship development and maintenance.
- Ability to travel
- for any list of duties/requirements/benefits. Use
for prose. We must preserve all substantive info; do not invent or summarize away detail. We must not include sections with filler like "commensurate with experience". Not relevant. We must not create Pay/Schedule/Benefits sections unless posting actually states them. It does state Pay Range, benefits, schedule (hybrid role requires both local travel and remote duties, ability to travel up to 75% of time). So we can include those sections. We need to decide which content goes where. Let's extract: About the role: Position Purpose paragraph. Responsibilities: The bullet list of duties: "Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements." "Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure." "Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)." "Identifies specific practice needs where Centene can provide support." "Develops, enhances and maintains provider clinical relationship across product lines." "Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards." "Ability to travel up to 75% of time to provider offices." "Performs other duties as assigned." "Complies with all policies and standards." Also earlier responsibilities: "Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers." Those could also be responsibilities. We'll combine. Requirements: Education/Experience: Bachelor's Degree or equivalent required; 3+ years in HEDIS record collection and risk adjustment (coding) required. Licenses/Certifications: list. Also Must be authorized to work in the U.S. without need for employment-based visa sponsorship now or in the future. Candidates must reside in Texas, with preference given to those located in East Houston (including Channelview, Baytown, Pasadena, Deer Park, and surrounding communities). This hybrid role requires both local travel and remote duties. Ability to travel up to 75% of time to provider offices. (Travel could be schedule but also requirement). We'll include in Requirements. Qualifications: Might be overlapping; but we could treat Qualifications as the licenses/certifications and education/experience? However we already used those in Requirements. To avoid duplication, we could put Qualifications as "Preferred qualifications" maybe none. But we need to include a section only if posting has real specific content. The posting does not separate "Qualifications" vs "Requirements". It has Education/Experience and Licenses/Certifications. Could treat those as Qualifications. But we already used them in Requirements. Perhaps we can split: Requirements: work authorization, residency, travel. Qualifications: education, experience, licenses/certifications. Skills: maybe HEDIS measures, coding, documentation, data analysis, collaboration, relationship building, etc. But we need to avoid inventing. We can extract skills from responsibilities: HEDIS measures, medical record documentation, ICD-9/10 CPT coding, quality improvement interventions, audits, provider relations, data collection/trending, coaching, etc. Those are substantive. We need to ensure we don't duplicate content across sections; but it's okay if some info appears in multiple sections? The instruction: "Preserve ALL substantive information; do NOT invent or summarize away detail." It doesn't forbid duplication, but better to avoid redundancy. However we need to follow the instruction to use sections only when posting has real specific content. We can allocate content accordingly. Let's design:
About the role
Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.
Responsibilities
- Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
- Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
- Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
- Identifies specific practice needs where Centene can provide support.
- Develops, enhances and maintains provider clinical relationship across product lines.
- Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
- Ability to travel up to 75% of time to provider offices.
- Performs other duties as assigned.
- Complies with all policies and standards.
Requirements
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
- Candidates must reside in Texas, with preference given to those located in East Houston (including Channelview, Baytown, Pasadena, Deer Park, and surrounding communities).
- This hybrid role requires both local travel and remote duties.
Qualifications
- Bachelor's Degree or equivalent required.
- 3+ years in HEDIS record collection and risk adjustment (coding) required.
- One of the following licenses/certifications required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS; Registered Health Information Technician (RHIT®) preferred for Superior HealthPlan.
Skills
- HEDIS measures knowledge and application.
- Medical record documentation guidelines.
- ICD-9/10 CPT coding.
- Quality improvement interventions and audits.
- Data collection, summarization, trending and reporting.
- Provider coaching and gap closure strategies.
- Collaboration with Provider Relations and cross‑functional teams.
- Provider relationship development and maintenance.
- Ability to travel