HEDIS & Risk-Adjustment Quality Advisor

Centene Corporation; Kentucky; Vor Ort; USD 37.000 - 67.000; Vollzeit

Zusammenfassung

Centene Corporation seeks a quality-focused HEDIS specialist to educate and support provider practices and IPAs on HEDIS measures, documentation, and coding practices across state and NCQA requirements.

You will collect and analyze performance data, coach on gap closure, and collaborate with Provider Relations to drive improvements in quality, risk adjustment, and operational efficiency. Significant travel (up to 75%) to provider offices is required, with a flexible, mission-driven environment.

Qualifikationen

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• RHIT certification or related licenses/certifications preferred; note Kentucky plan guidelines.
• Active licensure or certification to support HEDIS and coding tasks per state requirements.

Aufgaben

• Delivers, advises and educates provider practices and IPAs in HEDIS measures, medical record documentation guidelines, and HEDIS 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 and gap closure.
• 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 and maintains provider clinical relationships across product lines.
• Maintains Quality KPI and HEDIS abstraction accuracy as per standards.
• Complies with all policies and standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned.

Kenntnisse

HEDIS knowledge

Coding (HEDIS ICD-9/10 CPT)

Provider education

Data analysis

Travel readiness

Ausbildung

Bachelor's Degree or equivalent

3+ years in HEDIS record collection and risk adjustment

RHIT certification

Licenses/Certifications: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS

Kentucky plan: CADC, CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, CBCS

Jobbeschreibung

Centene Corporation seeks a quality-focused HEDIS specialist to educate and support provider practices and IPAs on HEDIS measures, documentation, and coding practices across state and NCQA requirements.

You will collect and analyze performance data, coach on gap closure, and collaborate with Provider Relations to drive improvements in quality, risk adjustment, and operational efficiency. Significant travel (up to 75%) to provider offices is required, with a flexible, mission-driven environment.