Quality Practice Advisor

Centene Corp.; Texas; Hybrid; USD 37,000 - 66,000; Full time

Job summary

Centene Corp. seeks a Quality Practice Advisor to educate provider practices and IPAs on NCQA HEDIS measures, medical record documentation, and coding. The hybrid remote role requires travel in Texas and surrounding areas.

Responsibilities include delivering education, analyzing quality and risk adjustment data, and partnering with Provider Relations to close clinical gaps. Requires a Bachelor's degree, 3+ years in HEDIS, and relevant licenses; sponsorship is not available.

Qualifications

• Bachelor's degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Licenses/certifications include CCS/LPN/LCSW/LMHC/LMSW/LMFT/LVN/RN/APRN/HCQM/CHP/CPHQ/CPC/CPC-A/CBCS.

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures, documentation guidelines and coding.
• Collects, trends and delivers provider quality and risk adjustment performance data.
• Collaborates with Provider Relations to improve provider performance and close gaps.
• Identifies specific practice needs where Centene can provide support.

Skills

HEDIS data collection

Risk adjustment coding

Provider education

Data trends and reporting

Education

Bachelor's degree or equivalent

3+ years HEDIS experience

Job description

## Quality Practice AdvisorApply: Remote-TX: Full time: Posted Yesterday: 1662939**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 be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT Candidates must reside in Texas, with preference given to those located in East Dallas/Northeast Texas (including Sulphur Springs, Longview,Paris, Gilmer, and surrounding communities). This hybrid role requires both local travel and remote duties.* 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 Superior HealthPlan:** license/certification is preferredPay Range: $27.02 - $48.55 per hour