Quality Practice Advisor

Oklahoma Complete Health; Oklahoma; Remote; Full time

Job summary

An established industry player is seeking a dedicated professional to enhance healthcare quality through HEDIS measures. In this remote role, you will work closely with providers to ensure compliance with state and federal standards, while fostering strong relationships within the healthcare community. Your expertise in HEDIS record collection and risk adjustment coding will be pivotal in driving quality improvement initiatives. This role offers a supportive environment with a focus on professional development, competitive pay, and a comprehensive benefits package. Join a mission-driven team committed to transforming healthcare for millions.

Benefits

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• 3+ years of experience in HEDIS record collection and risk adjustment coding.
• Bachelor's degree or equivalent required.

Responsibilities

• Educate providers on HEDIS measures and medical record documentation.
• Collaborate with teams to improve provider performance in Quality and Risk Adjustment.

Skills

HEDIS record collection

Risk adjustment coding

Provider education

Data analysis

Education

Bachelor's Degree

CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS

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.

THIS POSITION IS REMOTE/WORK FROM HOME. PREFER APPLICANTS WHO RESIDE IN THE STATE OF OKLAHOMA. WILL TRAVEL 10% TO DO PERIODIC PROVIDER OFFICE VISITS IF RESIDES IN OKLAHOMA. THIS ROLE IS SUPPORTING OUR OKLAHOMA COMPLETE HEALTH PLAN.

THE WORK SCHEDULE IS MONDAY - FRIDAY, 8AM - 5PM CENTRAL TIME ZONE. IDEAL APPLICANT WILL BE A NURSE WITH HEDIS BACKGROUND.

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 10% 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.

One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS required.

Pay Range: $26.50 - $47.59 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, 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. Total compensation may also include additional forms of incentives.

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.