Quality Practice Advisor

This position is a hybrid role that requires fieldwork. Qualified candidates must reside in the Corpus Christi, TX area. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

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.

Responsibilities

• Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.
• 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 relationships 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 the time to provider offices.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

• 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®): 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.
• Highly preferred licenses/certifications: LVN, RN, CPC, CPC-A, CRC, or CPHQ.

Pay

$27.02 - $48.55 per hour. 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

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules