Quality Practice Advisor

Centene Corporation; Illinois; Hybrid; USD 60,000 - 80,000; Full time

Job summary

Join a forward-thinking organization dedicated to transforming healthcare for millions. This hybrid role focuses on establishing relationships with providers while educating them on HEDIS measures and documentation standards. With a strong emphasis on quality improvement, you'll play a crucial role in ensuring compliance with state and federal standards. Enjoy a flexible work environment and a comprehensive benefits package, including competitive pay and opportunities for professional growth. If you have a passion for healthcare and a commitment to quality, this position offers a unique chance to make a significant impact in the community.

Benefits

Health insurance

401K plan

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• 3+ years of experience in HEDIS record collection and risk adjustment coding.
• Must possess one of the required certifications for the role.

Responsibilities

• Educate providers on HEDIS measures and coding requirements.
• Collaborate with teams to enhance provider performance in quality and operations.
• Collect and analyze provider quality performance data.

Skills

HEDIS record collection

Risk adjustment coding

Medical record documentation

Data analysis

Provider education

Education

Bachelor's Degree

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.

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.

1. 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.
2. 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.
3. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
4. Identifies specific practice needs where Centene can provide support.
5. Develops, enhances and maintains provider clinical relationship across product lines.
6. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
7. Ability to travel up to 75% of time to provider offices.
8. Performs other duties as assigned.
9. Complies with all policies and standards.

This is a HYBRID, provider-facing position. Candidates must reside in Madison, Sangamon, St. Clair, Macoupin, or Jersey counties.

Education/Experience:

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

One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS required.

For IL Health Plan only: Must reside in IL or within a reasonable driving distance to assigned providers.

Pay Range: $26.50 - $47.59 per hour.

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. Total compensation may also include additional forms of incentives.

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.