Quality Practice Advisor

Iowa Total Care; Iowa (LA); Hybrid; USD 37,000 - 68,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene is seeking a Provider Quality & HEDIS Specialist to foster relationships with large physician practices and IPAs, educating them on NCQA HEDIS measures and risk adjustment. The role supports documentation, coding accuracy and plan compliance with state and federal standards.

Travel to provider offices up to 75% and collaborate with provider relations to improve performance across Quality, Risk Adjustment, and Operations. Requires a Bachelor's degree and 3+ years in HEDIS.

Qualifications

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

Responsibilities

• Educates providers and supports NCQA HEDIS measures and risk adjustment.
• Delivers provider education on medical record documentation and coding.
• Collects, summarizes and trends provider quality data to identify opportunities for improvement.
• Travel up to 75% to provider offices.
• Maintain KPI and HEDIS abstraction accuracy.

Skills

Provider education

Stakeholder communication

Data interpretation

Education

Bachelor's degree or equivalent

3+ years HEDIS record collection and risk adjustment

Tools

CCS

LPN

RN

CPC

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.

• 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.

Must have reliable transportation and a valid drivers' license. Must live in the Central or Southeast IA area and be willing to travel up to 75% of the time.

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.

Pay Range: $27.02 - $48.55 per hour

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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