HEDIS Quality Advisor — Provider Education & Improvement

Centene Corporation; Frankfort (KY); Hybrid; USD 37,000 - 66,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules (remote/office

Job summary

Centene Corporation in Kentucky seeks a Clinical Quality Specialist to educate provider practices and IPAs on HEDIS measures and coding. You will collect and trend provider quality and risk adjustment data, collaborating with Provider Relations to improve performance across quality and operations.

Roles involve up to 75% travel to provider offices, maintaining NCQA and state standards, and supporting continuous improvement initiatives.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS certifications required.
• For Kentucky plan, CADC etc preferred, plus 3 years HEDIS experience.

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.

Skills

HEDIS

Risk adjustment

Provider education

Education

Bachelor's degree

RHIT certification

Tools

CPT coding

Job description

Centene Corporation in Kentucky seeks a Clinical Quality Specialist to educate provider practices and IPAs on HEDIS measures and coding. You will collect and trend provider quality and risk adjustment data, collaborating with Provider Relations to improve performance across quality and operations.

Roles involve up to 75% travel to provider offices, maintaining NCQA and state standards, and supporting continuous improvement initiatives.