Quality Practice Advisor

Centene Management Company LLC; Asheville (NC); Hybrid; USD 37,000 - 66,000; Full time

Job summary

Centene Management Company LLC is seeking a provider quality professional in North Carolina to educate and support physicians, IPAs and provider sites in NCQA HEDIS measures and risk adjustment. This hybrid role requires field travel to provider offices and close collaboration with Provider Relations teams.

The ideal candidate will have a Bachelor’s degree, 3+ years in HEDIS record collection and coding, and relevant certifications. RN licensure is highly preferred where applicable.

Qualifications

• Bachelor’s Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.

Responsibilities

• Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene.
• Educates providers and supports provider practice sites regarding NCQA HEDIS measures and risk adjustment.
• Provides education for HEDIS measures, appropriate medical record documentation and coding.
• Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards.
• Delivers, advises and educates provider practices and IPAs in HEDIS measures and coding per state, federal and NCQA requirements.
• Travels up to 75% to provider offices and collaborates with Provider Relations to improve performance.

Skills

HEDIS knowledge

Risk adjustment coding

Provider education

Relationship management

Education

Bachelor’s Degree or equivalent

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

This position is a hybrid role that requires fieldwork. Qualified candidates must reside in the state of North Carolina in one of the following counties:

• Avery
• Buncombe
• Burke
• Caldwell
• Cherokee
• Clay
• Graham
• Haywood
• Henderson
• Jackson
• Macon
• Madison
• McDowell
• Mitchell
• Polk
• Rutherford
• Swain
• Transylvania
• Yancey

RN licensure highly preferred.

Position Purpose

Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers. Delivers, advises and educates provider practices and IPAs in appropriate 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.

Education / Experience

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
• CBCS
• Registered Health Information Technician (RHIT®)

For positions aligned to a corporate line of business that report into and operate within a state specific health plan, state requirements apply.

Pay Range

$27.02 - $48.55 per hour

Benefits

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits may be subject to program eligibility.

Equal Opportunity / Diversity Statement

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Accommodation Statement

Should you need an accommodation, please email [e-mail].

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.