Quality Practice Advisor

Centene Corporation•Remote-LA, LA

4d•$27 - $49

About The Position

The Quality Practice Advisor establishes and fosters working relationships between large physician practices, IPAs, and Centene. The role educates and supports provider practices on NCQA HEDIS measures, risk adjustment, medical record documentation, and appropriate coding. It helps resolve deficiencies that affect plan compliance with state and federal HEDIS and documentation standards, and serves as a resource to health plan peers. The position also supports development and implementation of provider quality-improvement interventions and audits. The advisor delivers education and guidance to provider practices and IPAs on HEDIS measures, documentation guidelines, and HEDIS ICD-9/10 and CPT coding in accordance with state, federal, and NCQA requirements. The role collects, summarizes, trends, and shares provider quality and risk-adjustment performance data to identify improvement opportunities, coach providers, and close gaps. It collaborates with Provider Relations and other provider-facing teams to improve quality, risk adjustment, and operations performance, including claims and encounters; identifies practice support needs; and maintains clinical relationships across product lines. The advisor maintains Quality KPIs and HEDIS abstraction accuracy in accordance with corporate standards. Travel to provider offices may be up to 75% of the time. Other duties may be assigned, and the employee must comply with all policies and standards.

Requirements

Bachelor's degree or equivalent required.
At least 3 years of HEDIS record collection and risk-adjustment coding experience required.
One of the following is required, subject to the stated plan-specific exceptions: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS.
For positions aligned to a corporate line of business that report into and operate within a state-specific health plan, RHIT and applicable state requirements apply.
Ability to travel to provider offices up to 75% of the time.
For the IL Health Plan, must reside in Illinois or within a reasonable driving distance of assigned providers.

Nice To Haves

For the Kentucky plan, a listed license or certification is preferred but not required; CADC is also listed as preferred. Three years of HEDIS experience is specified.
For Trillium Community Health Plan / Oregon, no license or certification is required.
For Buckeye Health Plan, no license or certification is required.
For Superior HealthPlan, license or certification is preferred.
For Pennsylvania Health & Wellness, license or certification is preferred.
For Arkansas Total Care, the listed licenses or certifications are preferred.
For Magnolia Health, a license is preferred but not required with 3 or more years of HEDIS experience.
For Fidelis Care, no license or certification is required; certification is preferred.
For Managed Health Services - IN, no license or certification is required.
For the MI Health Plan, the listed licenses or certifications are preferred but not required.
For MHS Health WI, license or certification is not required.

Responsibilities

Establish and foster working relationships between large physician practices, IPAs, and Centene.
Educate and support provider practices on NCQA HEDIS measures, risk adjustment, medical record documentation, and appropriate coding.
Help resolve deficiencies affecting compliance with state and federal HEDIS and documentation standards.
Serve as a resource for health plan peers on HEDIS measures, documentation, and coding.
Support development and implementation of quality-improvement interventions and audits for plan providers.
Deliver education and guidance on HEDIS measures, documentation guidelines, and HEDIS ICD-9/10 and CPT coding in accordance with state, federal, and NCQA requirements.
Collect, summarize, trend, and deliver provider quality and risk-adjustment performance data to identify opportunities, coach providers, and close gaps.
Collaborate with Provider Relations and other provider-facing teams to improve provider performance in quality, risk adjustment, and operations, including claims and encounters.
Identify specific practice needs where Centene can provide support.
Develop, enhance, and maintain provider clinical relationships across product lines.
Maintain Quality KPIs and HEDIS abstraction accuracy rates in accordance with corporate standards.
Travel to provider offices up to 75% of the time.
Perform other duties as assigned and comply with all policies and standards.