HEDIS Quality Advisor for Provider Practices

Centene Corporation; Nevada (IA); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote, hybrid, field or office work

Job summary

Centene Corporation seeks a qualified professional to educate providers and IPAs on HEDIS measures, coding and documentation, while supporting quality improvement initiatives across plans. The role requires licensed credentials and Nevada residency with substantial travel.

Ideal candidates have HEDIS experience, medical coding skills, and health plan experience. This position emphasizes provider collaboration, data analysis and ongoing education to meet NCQA standards.

Qualifications

• Bachelor's degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• One of the listed licenses/certifications is required.

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures and coding per NCQA rules.
• Collects, summarizes trends and delivers provider quality and risk adjustment data.
• Collaborates to improve provider performance in Quality, Risk Adjustment and Operations.
• Identifies provider needs where Centene can provide support.
• Develops and maintains provider clinical relationships across products.
• Maintains Quality KPI and HEDIS abstraction accuracy per standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned.

Skills

HEDIS knowledge

Quality improvement

Provider education

Risk adjustment coding

Education

Bachelor's degree or equivalent

3+ years in HEDIS record collection and risk adjustment

Job description

Centene Corporation seeks a qualified professional to educate providers and IPAs on HEDIS measures, coding and documentation, while supporting quality improvement initiatives across plans. The role requires licensed credentials and Nevada residency with substantial travel.

Ideal candidates have HEDIS experience, medical coding skills, and health plan experience. This position emphasizes provider collaboration, data analysis and ongoing education to meet NCQA standards.