Quality Practice Advisor

centene; United States; Hybrid; USD 3,722,000 - 6,688,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Flexible work arrangements

Job summary

Centene Buckeye Health Plan in Ohio is seeking a Provider Relations Quality & HEDIS Specialist to educate and support physician practices and IPAs on NCQA HEDIS measures and risk adjustment. You will collect and trend performance data, collaborate with provider relations teams, and target improvement opportunities.

Travel up to 50% is required; candidates should have a Bachelor's degree and 3+ years in HEDIS/risk adjustment, with strong Excel and healthcare reporting skills.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Intermediate to advanced Excel and healthcare reporting skills highly preferred.
• Managed care or health insurance experience is highly preferred.
• Preferred experience interacting and working with provider groups, process improvement knowledge using QI methodologies.

Responsibilities

• Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene.
• Educates providers and supports provider practice sites regarding HEDIS measures and risk adjustment.
• 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.
• Travel up to 50% to provider offices and completions of other duties as assigned.

Skills

HEDIS

Risk Adjustment

Data Analysis

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 50% of time to provider offices.
• Performs other duties as assigned.
• Complies with all policies and standards.

Must reside in the state of OH and have the ability to travel up to 50% of the time. Reliable transportation and valid drivers' license and insurance is required.

Education/Experience:

Bachelor's Degree or equivalent required. 3+ years in HEDIS record collection and risk adjustment (coding) required. Intermediate to advanced excel and healthcare reporting skills highly preferred. Managed care or health insurance experience is highly preferred. Preferred experience interacting and working with provider groups, process improvement knowledge and application using QI science methodologies (i.e., IHI model for improvement or lean six sigma).

For Buckeye Health Plan -- No license/certification is required

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 Statement:

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