HEDIS Quality & Risk-Adjustment Advisor

centene; Nevada (IA); On-site; USD 37,000 - 67,000; Full time

Job summary

Centene is seeking a HEDIS and risk adjustment education specialist to collaborate with large physician practices and IPAs in Nevada. You will educate providers on NCQA HEDIS measures, documentation guidelines, and accurate coding to support plan compliance.

You’ll collect and summarize performance data, identify provider improvement opportunities, and work with provider relations to boost quality, risk adjustment, and operations. Travel up to 75%.

Qualifications

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

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of 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 knowledge

Risk adjustment coding

Provider education

Data analysis

Education

Bachelor's Degree or equivalent

3+ years in HEDIS record collection and risk adjustment

Job description

Centene is seeking a HEDIS and risk adjustment education specialist to collaborate with large physician practices and IPAs in Nevada. You will educate providers on NCQA HEDIS measures, documentation guidelines, and accurate coding to support plan compliance.

You’ll collect and summarize performance data, identify provider improvement opportunities, and work with provider relations to boost quality, risk adjustment, and operations. Travel up to 75%.