Quality Practice Advisor

Centene Corporation; Las Vegas (NV); On-site; USD 37,000 - 67,000; Full time

Job summary

Centene Corporation seeks a Provider Quality & HEDIS Specialist in Nevada to educate and support provider practices on NCQA HEDIS measures and risk adjustment. You will collect and analyze performance data, identify improvement opportunities, and coordinate with Provider Relations to close gaps.

The role requires a Bachelor's degree or equivalent and 3+ years in HEDIS data collection and coding. Up to 75% travel to provider offices is expected.

Qualifications

• Bachelor's degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Must reside in Nevada and be willing to travel up to 75% to provider offices.

Responsibilities

• Educates providers and IPAs on NCQA HEDIS measures, medical record documentation, and coding.
• Collects, summarizes, trends, and reports provider quality and risk adjustment data for improvement.
• Collaborates with Provider Relations to improve provider performance in Quality, Risk Adjustment and Operations.
• Supports development and implementation of quality improvement interventions and audits.
• Travel up to 75% to provider offices to perform duties.

Skills

HEDIS

Risk Adjustment

Provider Education

Coding

Education

Bachelor's degree or equivalent

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.

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 required3+ years in HEDIS record collection and risk adjustment (coding) required

Key Details:

Candidates must reside in Nevada, as this position requires occasional travel. One of the following active licenses or certifications is required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS. Preferred qualifications include provider experience, HEDIS knowledge, medical coding experience, quality improvement experience, and health plan experience.

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

About Centene:

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