HEDIS Quality Practice Advisor – Provider Education & Improvement

Centene Corporation; Kentucky; 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 plus holidays

Flexible work arrangements (remote,hyb

Job summary

Centene Corporation in Kentucky seeks a provider quality and education specialist to foster strong relationships with large physician practices and IPAs, educating on HEDIS measures, documentation, and coding. You will gather and analyze data to drive improvement and collaborate with Provider Relations to close gaps.

The role emphasizes travel up to 75% to provider offices, with a focus on ensuring plan compliance with state and federal standards for HEDIS and documentation.

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 coding according to state, federal and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify improvement opportunities.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality, Risk Adjustment and Operations.
• Identifies provider needs where Centene can provide support.
• Maintains Quality KPI and HEDIS abstraction accuracy rates.

Skills

HEDIS experience

Risk adjustment

Provider relations

Education delivery

Education

Bachelor's degree

HEDIS coding experience

RHIT certification

Job description

Centene Corporation in Kentucky seeks a provider quality and education specialist to foster strong relationships with large physician practices and IPAs, educating on HEDIS measures, documentation, and coding. You will gather and analyze data to drive improvement and collaborate with Provider Relations to close gaps.

The role emphasizes travel up to 75% to provider offices, with a focus on ensuring plan compliance with state and federal standards for HEDIS and documentation.