Quality Practice Advisor

Centene Corp.; Corpus Christi (TX); Hybrid; USD 37,000 - 68,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

Centene Corp. in Texas seeks a Health Quality Specialist to educate providers on HEDIS measures, documentation, and coding per NCQA standards. The role focuses on risk adjustment data collection and provider performance improvement.

The position is hybrid, requires travel up to 75%, and candidates must have a Bachelor's degree and 3+ years in HEDIS/risk adjustment. Licenses such as CPC/CPC-A or RN/LVN are highly preferred.

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 and educates provider practices and IPAs on HEDIS measures and coding per NCQA requirements.
• Collects, summarizes, trends and delivers provider quality and risk adjustment performance data.
• Collaborates with Provider Relations to improve provider performance in Quality, Risk Adjustment and Operations.
• Travels to provider offices up to 75% of the time.

Skills

HEDIS knowledge

Provider education

Coding (risk adjustment)

Data analysis

Travel up to 75%

Education

Bachelor's Degree or equivalent

Job description

**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. **Key Details:** 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 CPTThis position is a hybrid role that requires fieldwork. Qualified candidates must reside in the state of Texas, with preference given to those located in Corpus Christi and surrounding areas. Highly preferred licenses/certifications are LVN, RN, CPC, CPC-A, CRC, or CPHQ.* 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:** One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or 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 **For Superior HealthPlan:** license/certification is preferredPay Range: $27.02 - $48.55 per hour