HEDIS Quality Practice Advisor - Travel Ready

Managed Health Services (MHS); Indiana (PA); Hybrid; USD 3,722,000 - 6,688,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules

Job summary

Centene is seeking a HEDIS and risk adjustment specialist to collaborate with large physician practices and IPAs, educating on HEDIS measures and documentation requirements. The role involves data collection, trend analysis, and coaching to close gaps in quality performance across plans.

The candidate should have a Bachelor’s degree and 3+ years in HEDIS record collection and risk adjustment, with a range of certifications. The position supports travel up to 75% across IN and surrounding areas.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Certifications listed: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS.

Responsibilities

• Delivers, educates, and advises provider practices and IPAs in HEDIS measures, medical record documentation, and ICD-9/10 CPT coding per state, federal, and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify opportunities for improvement.
• Collaborates with Provider Relations and other provider-facing teams to improve performance in Quality, Risk Adjustment and Operations.
• Identifies specific practice needs where Centene can provide support.
• Develops, enhances and maintains provider clinical relationships across product lines.
• Maintains Quality KPI and HEDIS Abstraction accuracy per corporate standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned and complies with policies.

Skills

HEDIS measures

Risk adjustment coding

Provider education

Education

Bachelor's degree

Job description

Centene is seeking a HEDIS and risk adjustment specialist to collaborate with large physician practices and IPAs, educating on HEDIS measures and documentation requirements. The role involves data collection, trend analysis, and coaching to close gaps in quality performance across plans.

The candidate should have a Bachelor’s degree and 3+ years in HEDIS record collection and risk adjustment, with a range of certifications. The position supports travel up to 75% across IN and surrounding areas.