HEDIS Quality & Provider Education Lead (Remote)

centene; Iowa (LA); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene is seeking a HEDIS and risk adjustment specialist to educate provider practices and IPAs on HEDIS measures, medical record documentation, and coding in line with NCQA requirements. You will collect and analyze provider quality and risk adjustment data to identify improvement opportunities and coach providers.

Collaboration with Provider Relations will help raise performance in Quality, Risk Adjustment, and Operations.

Qualifications

• Bachelor's degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Knowledge of NCQA requirements and HEDIS measures preferred.

Responsibilities

• Delivers and educates providers on HEDIS measures and coding per regulations.
• Collects, summarizes, and trends provider quality and risk adjustment data.
• Collaborates with Provider Relations to improve performance.
• Identifies provider support needs for Centene.
• Maintains provider relationships across product lines.
• Adheres to quality KPI and HEDIS abstraction standards.
• Travel up to 75% to provider offices.
• Performs other duties as assigned.

Skills

HEDIS knowledge

Provider education

Coding (CPT/ICD-9/10)

Data analysis

Education

Bachelor's Degree or equivalent

Job description

Centene is seeking a HEDIS and risk adjustment specialist to educate provider practices and IPAs on HEDIS measures, medical record documentation, and coding in line with NCQA requirements. You will collect and analyze provider quality and risk adjustment data to identify improvement opportunities and coach providers.

Collaboration with Provider Relations will help raise performance in Quality, Risk Adjustment, and Operations.