Quality Practice Advisor
About The Position
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. Requires 50% travel Region 1 - Paducah, KY (south Evansville to TN line) North Indiana, IL, through KY Mayfield, Ky – Hopkinsville
Requirements
- Bachelor's Degree or equivalent required
- 3+ years in HEDIS record collection and risk adjustment (coding) required
- One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS Registered Health Information Technician (RHIT®)
- For positions aligned to a corporate line of business that report into and operate within a state specific health plan, state requirements apply
Nice To Haves
- For the Kentucky plan only: License/Certification preferred, not required: CADC, CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS, + 3 years HEDIS experience
Responsibilities
- 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.
Benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
