Quality Practice Advisor

Centene Corp.; Oregon; 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 and holidays

Job summary

Centene Corp. is seeking a provider education and HEDIS specialist to partner with large physician practices and IPAs. You will educate teams on NCQA HEDIS measures, risk adjustment coding, and documentation to support plan compliance and quality improvements.

The role requires 75% travel to provider offices, collaboration with provider relations, and maintaining quality KPIs across product lines. A Bachelor’s degree and 3+ years in HEDIS/risk adjustment are required.

Qualifications

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

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures and coding per NCQA requirements.
• Collects, summarizes and delivers provider quality and risk adjustment performance data.
• Collaborates with provider relations to improve performance in quality and operations.
• Identifies provider needs where Centene can provide support.
• Develops and maintains provider clinical relationships across product lines.
• Maintains Quality KPI and HEDIS abstraction accuracy per standards.
• Travel up to 75% to provider offices.

Education

Bachelor's Degree

3+ years HEDIS record collection

3+ years 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 Details

Must reside in Louisiana. Location Preference is New Orleans or Baton Rouge. HEDIS experience highly preferred.

• 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.

Pay Range: $27.02 - $48.55 per hour.

Benefits

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.

Equal Opportunity

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.

Additional Information

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.