Quality Practice Advisor, HEDIS & Provider Education

PA Health & Wellness; Pennsylvania; On-site; 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 is seeking a Quality Improvement/HEDIS educator to work with community physicians and small practices around HEDIS measures and medical record documentation. You will educate on NCQA guidelines, review records, and help providers close gaps in care while tracking outcomes.

Travel up to 75% in the Southeast Pennsylvania area; a bachelor's degree is required and a Master’s is preferred. Experience with data analysis and medical coding is valued; licensure in related fields is a plus.

Qualifications

• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience.
• A Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field is preferred.
• 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews or 2 years medical coding or equivalent.

Responsibilities

• Educates community physician and small provider practices in HEDIS measures and coding per NCQA requirements.
• Collects, summarizes and trends provider performance data to identify improvement opportunities.
• Collaborates with Provider Relations to improve 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 to encourage member clinical participation in wellness and education.
• Provides resources and education to providers and staff.
• Documents action plans and outcomes of visits.

Skills

HEDIS knowledge

Provider education

Data trends analysis

Medical coding exposure

Education

Bachelor's degree in Healthcare, Public Health, Nursing, or related field

Master's degree preferred

Job description

Centene is seeking a Quality Improvement/HEDIS educator to work with community physicians and small practices around HEDIS measures and medical record documentation. You will educate on NCQA guidelines, review records, and help providers close gaps in care while tracking outcomes.

Travel up to 75% in the Southeast Pennsylvania area; a bachelor's degree is required and a Master’s is preferred. Experience with data analysis and medical coding is valued; licensure in related fields is a plus.