Quality Practice Advisor – HEDIS & Provider Education

PA Health & Wellness; Bent Creek (NC); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K plan

Stock purchase program

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a Quality Practice Advisor focused on HEDIS measure education and medical record review to support provider practices across the Southeast region. You will educate providers on NCQA requirements, review medical records, and coach staff to close gaps in care while ensuring compliance with state and federal standards.

In this role, you will analyze provider performance, collaborate with Provider Relations, and deliver actionable education resources.

Qualifications

• Bachelor's degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field required or equivalent work experience in a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets.
• Master's preferred. 1+ year of experience in HEDIS medical record review or quality improvement, or 2 years medical coding or related transferable experience.

Responsibilities

• Educates community physicians and small provider practices in NCQA HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding.
• Collects, summarizes and trends provider performance data to identify improvement opportunities.
• Collaborates with Provider Relations to improve provider performance in Quality, Risk Adjustment and Operations.
• Delivers provider-specific metrics and coaches on gap closing opportunities.
• Identifies practice needs where WellCare can provide support.
• Partners with physicians and staff to encourage member participation in wellness and education.
• Provides resources and educational opportunities to provider staff.

Education

Bachelor's degree in Healthcare or related field

Master's Degree in Healthcare or related field (preferred)

Job description

Centene is seeking a Quality Practice Advisor focused on HEDIS measure education and medical record review to support provider practices across the Southeast region. You will educate providers on NCQA requirements, review medical records, and coach staff to close gaps in care while ensuring compliance with state and federal standards.

In this role, you will analyze provider performance, collaborate with Provider Relations, and deliver actionable education resources.