Quality Practice Advisor

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.

Responsibilities

• 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
• 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

• Bachelor's Degree or equivalent required
• 3+ years in HEDIS record collection and risk adjustment (coding) required
• Must have reliable transportation and a valid drivers' license
• Must live in the Central or Eastern IA area and be willing to travel up to 75% of the time

Licenses/Certifications

One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS.

Pay

$27.02 - $48.55 per hour

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.