Quality Practice Advisor

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

📋 Description

• Cultivates and maintains a positive working relationship between large physician practices, IPAs, and Centene.

• Provides education to providers and supports practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment.

• Offers training on HEDIS measures, appropriate medical record documentation, and correct coding practices.

• Aids in addressing deficiencies that affect plan compliance to ensure adherence to State and Federal standards for HEDIS and documentation requirements.

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

• Assists in the development and execution of quality improvement initiatives and audits related to plan providers.

• Educates and advises provider practices and IPAs on appropriate HEDIS measures, medical record documentation guidelines, and HEDIS ICD-9/10 CPT coding in line with state, federal, and NCQA standards.

• Gathers, analyzes, trends, and presents provider quality and risk adjustment performance data to identify and strategize opportunities for provider enhancement and gap closure.

• Works in collaboration with Provider Relations and other provider-facing teams to boost provider performance in Quality, Risk Adjustment, and Operations (claims and encounters).

• Recognizes specific practice needs where Centene can offer support.

• Develops, improves, and sustains clinical relationships with providers across various product lines.

• Maintains Quality KPI and ensures compliance with HEDIS Abstraction accuracy rates as per corporate benchmarks.

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

• Performs additional duties as required and adheres to all policies and standards.

⛳️ Requirements

• LPN or RN (compact license)

• Experience with HEDIS measures

• Background in provider education

• Knowledge of risk adjustment

• Bachelor's Degree or equivalent is required

• 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

🏝️ Benefits

• Competitive salary

• Health insurance coverage

• 401K and stock purchase options

• Tuition reimbursement program

• Paid time off along with holidays

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