Advisor, Medical - Virtual

Centene Corporation; Lexington (KY); Sur place; USD 37 000 - 67 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K

Tuition reimbursement

Paid time off

Résumé du poste

Centene Corporation in Lexington, KY seeks a HEDIS and Risk Adjustment specialist to educate providers, collect quality data, and support NCQA standards across plan providers.

This role requires 3+ years in HEDIS data collection and coding, a Bachelor's degree, and willingness to travel. Centene offers comprehensive benefits and a collaborative work environment.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• State license/certification related to health information preferred (see KY plan notes).

Responsabilités

• Educates providers on HEDIS measures and coding guidelines.
• Delivers education to provider practices and IPAs on NCQA requirements.
• Collects and analyzes provider quality and risk adjustment data to identify improvement opportunities.
• Collaborates with Provider Relations to improve performance in Quality, Risk Adjustment and Operations.

Connaissances

HEDIS knowledge

Risk adjustment

Provider education

Data analysis

Formation

Bachelor's degree

Description du poste

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.

Key Details

• 50% of travel is required. Travel Region 1 - Paducah, KY (south Evansville to TN line) North Indiana, IL, through KY Mayfield, Ky – Hopkinsville
• ~ Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
• ~ Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
• ~ Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
• ~ Identifies specific practice needs where Centene can provide support.
• ~ Develops, enhances and maintains provider clinical relationship across product lines.
• ~ Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned.
• ~ Complies with all policies and standards.

Education / Experience

Bachelor's Degree or equivalent required

Qualifications

3+ years in HEDIS record collection and risk adjustment (coding) required

Licenses / Certifications

• 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®): 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 Range

$27.02 - $48.55 per hour

About Centene

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits

Centene offers a 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. 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. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Equal Opportunity

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act