Quality Practice Advisor

WellCare of Kentucky; Kentucky; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene is seeking a Quality Improvement professional to educate provider practices on HEDIS measures and risk adjustment, support documentation, and improve coding accuracy. The role involves extensive travel to physician offices and collaboration with provider relations and QA teams.

The ideal candidate has a Bachelor's degree and 3+ years in HEDIS data collection, with multiple certifications in health quality and coding.

Qualifications

• HEDIS data collection and risk adjustment experience required.
• Bachelor's degree or equivalent required.
• Knowledge of NCQA guidelines and medical record documentation.

Responsibilities

• Establishes strong working relationships with large physician practices, IPAs and Centene.
• Educates providers on NCQA HEDIS measures and risk adjustment.
• Delivers education on HEDIS measures, documentation and coding guidelines.
• Assists in resolving deficiencies to meet state and federal standards.
• Acts as a resource on HEDIS measures and coding for health plan teams.
• Travel up to 75% to provider offices; supports provider relations and QA activities.

Skills

HEDIS knowledge

Risk adjustment coding

Provider education

Education

Bachelor's Degree or equivalent

HEDIS data collection experience

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.

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:

50% of travel is required. Travel Region 1 - Paducah, KY (south Evansville to TN line) North Indiana, IL, through KY Mayfield, Ky – Hopkinsville

• 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 the Kentucky plan only:

License/Certification preferred, not required: CADC, CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS, + 3 years HEDIS experience

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