Quality Practice Advisor

Centene Corporation•Corpus Christi, TX

11d•$27 - $49•Hybrid

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. This position is a hybrid role that requires fieldwork. Qualified candidates must reside in the state of Texas, with preference given to those located in Corpus Christi and surrounding areas. Ability to travel up to 75% of time to provider offices. Performs other duties as assigned. Complies with all policies and standards.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Qualified candidates must reside in the state of Texas.
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
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 those located in Corpus Christi and surrounding areas.
Highly preferred licenses/certifications are LVN, RN, CPC, CPC-A, CRC, or CPHQ.

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 relationship across product lines.
Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.