Quality Practice Advisor

Centene Corporation•Remote-TX, TX

1d•$27 - $49•Hybrid

About The Position

Centene is seeking a Quality Practice Advisor to establish and foster strong working relationships between large physician practices, IPAs, and Centene. This role involves educating providers and supporting practice sites on National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. The advisor will provide education on HEDIS measures, appropriate medical record documentation, and coding, while assisting in resolving deficiencies that impact plan compliance with State and Federal standards. Additionally, the position serves as a resource for health plan peers on HEDIS measures, documentation, and coding, and supports the development and implementation of quality improvement interventions and audits related to plan providers.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Candidates must reside in Texas, with preference given to those located in East Texas (including Beaumont, Port Arthur, and surrounding communities).
Bachelor's Degree or equivalent required.
3+ years in HEDIS record collection and risk adjustment (coding) required.
One of the following certifications required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS.
For Superior HealthPlan: license/certification is preferred.
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

Preference given to candidates located in East Texas (including Beaumont, Port Arthur, and surrounding communities).

Responsibilities

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 relationships across product lines.
Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
Performs other duties as assigned.
Complies with all policies and standards.