Quality Practice Advisor

Centene Corporation; Kentucky; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements (remote,hyb

Job summary

Centene Corporation in Kentucky seeks a provider quality and education specialist to foster strong relationships with large physician practices and IPAs, educating on HEDIS measures, documentation, and coding. You will gather and analyze data to drive improvement and collaborate with Provider Relations to close gaps.

The role emphasizes travel up to 75% to provider offices, with a focus on ensuring plan compliance with state and federal standards for HEDIS and documentation.

Qualifications

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

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures, medical record documentation and coding according to state, federal and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify improvement opportunities.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality, Risk Adjustment and Operations.
• Identifies provider needs where Centene can provide support.
• Maintains Quality KPI and HEDIS abstraction accuracy rates.

Skills

HEDIS experience

Risk adjustment

Provider relations

Education delivery

Education

Bachelor's degree

HEDIS coding experience

RHIT certification

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.

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

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules

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