Quality Practice Advisor

Centene Corporation; United States; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote, hybrid, field or office work

Job summary

Centene Corporation seeks a Provider Quality Improvement specialist to educate and support provider practices on HEDIS measures and proper medical record documentation and coding.

You will collect and analyze performance data, collaborate with Provider Relations, and drive improvements in quality and risk adjustment across networks. Travel up to 75% is required, with flexible scheduling options.

Qualifications

• Bachelor’s degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• HEDIS coding with ICD-9/10 and CPT guidelines experience preferred.

Responsibilities

• Delivers, educates and advises provider practices on HEDIS measures and coding.
• Collects, summarizes, trends and reports provider quality and risk adjustment performance.
• Collaborates with Provider Relations to improve quality, risk adjustment and operations.
• Identifies provider needs and supports improvement opportunities.
• Maintains provider relationships across product lines and ensures compliance.
• Travel to provider offices as required, up to 75% of the time.

Skills

HEDIS measures

Provider education

Coding (CPT/ICD-9/10)

Risk adjustment

Education

Bachelor's degree or equivalent

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.

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.

Must have reliable transportation and a valid drivers' license. Must live in the Central or Eastern IA area and be willing to travel up to 75% of the time.

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

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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