Quality Practice Advisor

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Build and nurture strong working relationships with large physician practices, IPAs, and Centene.

• Provide education to providers and support practice sites on NCQA HEDIS measures and risk adjustment.

• Educate on HEDIS measures, medical record documentation, and correct coding practices.

• Assist in addressing deficiencies that impact compliance with State and Federal HEDIS and documentation standards.

• Act as a resource for health plan colleagues regarding HEDIS measures, documentation, and coding.

• Aid in the development and execution of quality improvement initiatives and provider-related audits.

• Guide and inform provider practices and IPAs on HEDIS measures, documentation protocols, and HEDIS ICD-9/10 CPT coding.

• Gather, analyze, trend, and present provider quality and risk adjustment performance data to identify opportunities for improvement and gap closure.

• Work collaboratively with Provider Relations and other provider-facing teams to enhance Quality, Risk Adjustment, and Operations performance.

• Recognize practice needs where Centene can offer assistance.

• Cultivate, improve, and sustain provider clinical relationships across various product lines.

• Ensure Quality KPIs and HEDIS abstraction accuracy rates meet corporate standards.

• Perform additional duties as assigned and adhere to all policies and standards.

⛳️ Requirements

• A Bachelor's Degree or equivalent is required.

• A minimum of 3 years in HEDIS record collection and risk adjustment (coding) is required.

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

• RHIT®: state-specific requirements apply for positions related to a corporate line of business operating within a state-specific health plan.

• Willingness to travel 50% or more; up to 75% of time to provider offices.

• For the Kentucky plan only, the listed licenses/certifications are preferred but not mandatory, alongside 3 years of HEDIS experience.

🏝️ Benefits

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office work schedules.

• Additional incentive options may be included in total compensation.