Quality Practice Advisor

Jobtailor; Indianapolis (IN); On-site; USD 70,000 - 95,000; Full time

Job summary

Centene is seeking a HEDIS Quality Analyst to establish and maintain productive relationships with large physician practices and IPAs, ensuring accuracy in documentation and coding. You will educate providers on NCQA HEDIS measures, risk adjustment, and medical record documentation, and lead quality improvement projects across provider networks.

Travel up to 75% may be required to support Indiana facilities and adjacent markets.

Qualifications

• Bachelor's degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding).
• NCQA HEDIS measures knowledge and documentation standards expected.
• Proven ability to educate providers and support practices.
• Willingness to travel up to 75% of the time.

Responsibilities

• Establish and foster healthy working relationships between large physician practices, IPAs and Centene.
• Educate providers and support provider practice sites regarding NCQA HEDIS measures and risk adjustment.
• Provide education on HEDIS measures, medical record documentation, and appropriate coding.
• Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS and documentation standards.
• Serve as a resource for health plan peers on HEDIS measures, documentation, and coding.
• Support development and implementation of quality improvement interventions and provider-related audits.
• Deliver advice and education to provider practices and IPAs on HEDIS measures, documentation guidelines, and HEDIS ICD-9/10 CPT coding.
• Collect, summarize, trend, and deliver provider quality and risk adjustment performance data.
• Identify and strategize or coach on provider improvement and gap-closure opportunities.
• Collaborate with Provider Relations and other provider-facing teams to improve performance in Quality, Risk Adjustment, and Operations.
• Identify practice needs where Centene can provide support.
• Develop, enhance, and maintain provider clinical relationships across product lines.
• Maintain Quality KPIs and HEDIS abstraction accuracy rates according to corporate standards.
• Travel to provider offices up to 75% of the time.
• Comply with policies and standards and perform other assigned duties.

Skills

HEDIS Record Collection

Risk Adjustment Coding

ICD-9/10 CPT Coding

Medical Record Documentation

Data Analysis

Quality KPI Maintenance

Provider Education

Documentation Guidelines

Gap-Closure Strategies

Provider Audits

Education

Bachelor's Degree or equivalent

Job description

Responsibilities

• Establish and foster healthy working relationships between large physician practices, IPAs and Centene


• Educate providers and support provider practice sites regarding NCQA HEDIS measures and risk adjustment


• Provide education on HEDIS measures, medical record documentation, and appropriate coding


• Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS and documentation standards


• Serve as a resource for health plan peers on HEDIS measures, documentation, and coding


• Support development and implementation of quality improvement interventions and provider-related audits


• Deliver advice and education to provider practices and IPAs on HEDIS measures, documentation guidelines, and HEDIS ICD-9/10 CPT coding


• Collect, summarize, trend, and deliver provider quality and risk adjustment performance data


• Identify and strategize or coach on provider improvement and gap-closure opportunities


• Collaborate with Provider Relations and other provider-facing teams to improve performance in Quality, Risk Adjustment, and Operations


• Identify practice needs where Centene can provide support


• Develop, enhance, and maintain provider clinical relationships across product lines


• Maintain Quality KPIs and HEDIS abstraction accuracy rates according to corporate standards


• Travel to provider offices up to 75% of the time


• Comply with policies and standards and perform other assigned duties

Requirements

• 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, CPC-A or CBCS


• For Managed Health Services - IN, no license/certification is required


• Reliable transportation required


• Valid driver's license and insurance required


• Must be local to the Indianapolis, IN area


• Willingness to travel up to 75% of the time


• Knowledge of NCQA HEDIS measures, risk adjustment, medical record documentation, and ICD-9/10 CPT coding

Core Competencies

Demonstrates expertise in HEDIS measures, risk adjustment, and medical record documentation, while effectively educating and collaborating with provider practices to enhance quality and compliance. Proven ability to analyze performance data and implement quality improvement interventions.

Highest-signal resume keywords

• HEDIS Record Collection


• Risk Adjustment Coding


• NCQA HEDIS Measures


• ICD-9/10 CPT Coding


• Quality Improvement Interventions

Hard Skills

• HEDIS Record Collection


• Risk Adjustment Coding


• ICD-9/10 CPT Coding


• Medical Record Documentation


• Data Analysis


• Quality KPI Maintenance


• Provider Education


• Documentation Guidelines


• Gap-Closure Strategies


• Provider Audits

Soft Skills

• Relationship Building


• Collaboration


• Coaching


• Communication


• Problem Solving

Certifications & Qualifications

• CCS


• LPN


• LCSW


• LMHC


• LMSW


• LMFT


• LVN


• RN


• APRN


• HCQM

Industry Keywords

• HEDIS


• NCQA


• Managed Health Services


• Quality Improvement


• Risk Adjustment


• Provider Relations


• Compliance Standards


• Documentation Standards


• Healthcare Quality


• Provider Practices