Quality Practice Advisor

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

📋 Description

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

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

• Deliver training on HEDIS measures, medical record documentation, and coding practices.

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

• Serve 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 audits.

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

• Gather, summarize, analyze, and present provider quality and risk adjustment performance data.

• Identify opportunities for provider improvement and gap closure; strategize and coach on necessary interventions.

• Collaborate with Provider Relations and other teams interacting with providers to enhance Quality, Risk Adjustment, and Operations performance.

• Recognize practice needs where Centene can offer assistance.

• Develop, enhance, and sustain provider clinical relationships across various product lines.

• Maintain Quality KPIs and HEDIS abstraction accuracy rates in line with corporate standards.

• Travel to provider offices as necessary, potentially up to 75% of the time.

• Carry out other assigned responsibilities and adhere to policies and standards.

⛳️ Requirements

• Must be a resident of Louisiana.

• Preferred locations include New Orleans or Baton Rouge.

• Previous HEDIS experience is highly desirable.

• A Bachelor's Degree or equivalent is required.

• Minimum of 3 years of experience 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® qualifications apply for positions aligned with a corporate line of business operating within a state-specific health plan.

• Familiarity with NCQA HEDIS measures, medical record documentation, risk adjustment, and HEDIS ICD-9/10 CPT coding is essential.

• Willingness to travel up to 75% of the time to provider offices.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase opportunities.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in total compensation.