Quality Practice Advisor

Centene Corporation; Nevada; On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Holidays

Flexible work schedules

Job summary

Centene Corporation in Nevada is seeking a HEDIS Specialist to educate and support provider practices on NCQA HEDIS measures, documentation and coding, traveling as needed. You will deliver education, collect and analyze quality data, and collaborate with Provider Relations to improve performance.

The role requires a Bachelor's degree and 3+ years in HEDIS record collection and risk adjustment, with relevant licenses. Travel up to 75% may be required and compensation ranges per hour are provided.

Qualifications

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

Responsibilities

• Delivers, educates and advises provider practices and IPAs in HEDIS measures, medical record documentation guidelines and HEDIS CPT coding.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data.
• Collaborates with Provider Relations to improve provider performance in Quality, Risk Adjustment and Operations (claims and encounters).
• Identifies providers' needs where Centene can provide support.
• Maintains provider relationships across product lines.
• Maintains Quality KPI and HEDIS abstraction accuracy per standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned.

Education

Bachelor's Degree or equivalent

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

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.

Key Detail s

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.

• 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
• 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. 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