HEDIS & Risk-Adjustment Quality Advisor — Travel

WellCare of Kentucky; Kentucky; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene is seeking a Quality Improvement professional to educate provider practices on HEDIS measures and risk adjustment, support documentation, and improve coding accuracy. The role involves extensive travel to physician offices and collaboration with provider relations and QA teams.

The ideal candidate has a Bachelor's degree and 3+ years in HEDIS data collection, with multiple certifications in health quality and coding.

Qualifications

• HEDIS data collection and risk adjustment experience required.
• Bachelor's degree or equivalent required.
• Knowledge of NCQA guidelines and medical record documentation.

Responsibilities

• Establishes strong working relationships with large physician practices, IPAs and Centene.
• Educates providers on NCQA HEDIS measures and risk adjustment.
• Delivers education on HEDIS measures, documentation and coding guidelines.
• Assists in resolving deficiencies to meet state and federal standards.
• Acts as a resource on HEDIS measures and coding for health plan teams.
• Travel up to 75% to provider offices; supports provider relations and QA activities.

Skills

HEDIS knowledge

Risk adjustment coding

Provider education

Education

Bachelor's Degree or equivalent

HEDIS data collection experience

Job description

Centene is seeking a Quality Improvement professional to educate provider practices on HEDIS measures and risk adjustment, support documentation, and improve coding accuracy. The role involves extensive travel to physician offices and collaboration with provider relations and QA teams.

The ideal candidate has a Bachelor's degree and 3+ years in HEDIS data collection, with multiple certifications in health quality and coding.