Quality Practice Advisor
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.
Requirements
- Requires 50% travel
- Bachelor's Degree or equivalent required
- 3+ years in HEDIS record collection and risk adjustment (coding) required
- 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®)
Qualifications
- For positions aligned to a corporate line of business that report into and operate within a state specific health plan, state requirements apply
- For the Kentucky plan only: License/Certification preferred, not required: CADC, CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS, + 3 years HEDIS experience
Pay
Pay Range: $27.02 - $48.55 per hour
Benefits
- 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.
- Total compensation may also include additional forms of incentives.
- Benefits may be subject to program eligibility.
About the Role
Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Schedule
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.
Skills
Knowledge of NCQA HEDIS measures, risk adjustment, medical record documentation, and appropriate coding. Ability to resolve deficiencies impacting plan compliance and support quality improvement interventions and audits.
Benefits
- 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.
- Total compensation may also include additional forms of incentives.
- Benefits may be subject to program eligibility.
Pay
Pay Range: $27.02 - $48.55 per hour
Equal Opportunity Employer
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.