HEDIS Quality Advisor: Provider Education & Risk Adjustment

Centene Corporation; Corpus Christi (TX); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (hybrid/field/

Remote/office flexibility

Job summary

Centene Corporation in Texas seeks a qualified professional to educate and assist provider practices on HEDIS measures, documentation, and coding to ensure NCQA standards are met. The role involves data collection and trend analysis to identify opportunities for provider improvement and plan performance.

The position collaborates with Provider Relations and other teams to enhance quality and risk adjustment outcomes across product lines, requiring a strong background in HEDIS coding and

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures, medical record documentation and HEDIS coding per state, federal, and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify opportunities for provider improvement and gap closure.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in 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.

Skills

HEDIS data collection

Risk adjustment coding

Provider education

Education

Bachelor's degree or equivalent

Job description

Centene Corporation in Texas seeks a qualified professional to educate and assist provider practices on HEDIS measures, documentation, and coding to ensure NCQA standards are met. The role involves data collection and trend analysis to identify opportunities for provider improvement and plan performance.

The position collaborates with Provider Relations and other teams to enhance quality and risk adjustment outcomes across product lines, requiring a strong background in HEDIS coding and