Quality Practice Advisor

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

📋 Description

• Build and maintain strong working relationships between large physician practices, IPAs, and Centene.

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

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

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

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

• Contribute to the development and execution of quality improvement initiatives and provider-related audits.

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

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

• Identify opportunities for provider enhancements and gap closure; strategize and mentor providers accordingly.

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

• Recognize practice needs where Centene can lend support.

• Cultivate, strengthen, and maintain clinical relationships with providers across various product lines.

• Ensure Quality KPIs and HEDIS abstraction accuracy rates are upheld according to corporate standards.

• Travel to provider offices up to 50% of the time.

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

⛳️ Requirements

• Must be a resident of Ohio.

• Willingness to travel up to 50% of the time to provider offices.

• Reliable transportation is mandatory.

• A valid driver's license and insurance are required.

• A Bachelor's Degree or equivalent is mandatory.

• At least 3 years of experience in HEDIS record collection and risk adjustment coding is essential.

• Intermediate to advanced skills in Excel are highly preferred.

• Skills in healthcare reporting are highly preferred.

• Experience in managed care or health insurance is highly preferred.

• Preferred experience in interacting and working with provider groups.

• Knowledge of process improvement and its application using QI science methodologies is preferred, including the IHI model for improvement or Lean Six Sigma.

• No specific license or certification is required for Buckeye Health Plan.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase plans available.

• Tuition reimbursement programs.

• Paid time off along with holidays.

• Flexible working arrangements with options for remote, hybrid, field, or office work schedules.

• Additional forms of incentives may be included in total compensation.