Quality Practice Advisor

Managed Health Services (MHS); Indiana (PA); Hybrid; USD 3,722,000 - 6,688,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules

Job summary

Centene is seeking a HEDIS and risk adjustment specialist to collaborate with large physician practices and IPAs, educating on HEDIS measures and documentation requirements. The role involves data collection, trend analysis, and coaching to close gaps in quality performance across plans.

The candidate should have a Bachelor’s degree and 3+ years in HEDIS record collection and risk adjustment, with a range of certifications. The position supports travel up to 75% across IN and surrounding areas.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Certifications listed: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS.

Responsibilities

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

Skills

HEDIS measures

Risk adjustment coding

Provider education

Education

Bachelor's degree

Job description

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.
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 have reliable transportation, valid drivers' license and insurance.
Must be local to the Indianapolis, IN area and willing to travel up to 75% of the time.

• 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.
For Managed Health Services - IN -- No license/certification is required.
Pay Range: $27.02 - $48.55 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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.
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