HEDIS & Quality Advisor - Provider Relations (Hybrid)

Buckeye Health Plan; Kentucky; On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work with remote, hybrid, or?

Job summary

Buckeye Health Plan is seeking a Quality Improvement professional to establish strong relationships with large physician practices and IPAs across the state. You will educate providers on NCQA HEDIS measures and risk adjustment, review medical records, and support coding accuracy to maintain plan compliance.

The role requires travel up to 50% and a Bachelor's degree with 3+ years in HEDIS/risk adjustment. Healthcare reporting and QA methodology experience are highly valued.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Intermediate to advanced excel and healthcare reporting skills highly preferred.
• Managed care or health insurance experience is highly preferred.
• Preferred experience interacting and working with provider groups, process improvement knowledge and application using QI science methodologies.

Responsibilities

• Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene.
• Educates providers and supports provider practice sites regarding NCQA HEDIS measures and risk adjustment.
• Provides education for HEDIS measures, appropriate medical record documentation and coding.
• Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards.
• Delivers provider quality performance data to identify opportunities for improvement and coach on gaps.
• Travels up to 50% to provider offices.
• Performs other duties as assigned.

Skills

HEDIS data collection

risk adjustment

excel

healthcare reporting

QI science

Education

Bachelor's Degree

Tools

Excel

Job description

Buckeye Health Plan is seeking a Quality Improvement professional to establish strong relationships with large physician practices and IPAs across the state. You will educate providers on NCQA HEDIS measures and risk adjustment, review medical records, and support coding accuracy to maintain plan compliance.

The role requires travel up to 50% and a Bachelor's degree with 3+ years in HEDIS/risk adjustment. Healthcare reporting and QA methodology experience are highly valued.