Quality Practice Advisor

Centene Corporation

122d • $26 - $47

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This is a hybrid remote role that meets directly with provider groups based in the Chicago area to discuss HEDIS performance and strategize ways to improve performance, up to 75% travel. Typical daily tasks will include creating/using PowerPoint presentations, creating/exporting reports, and data analysis.

Requirements

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.

Nice To Haves

• One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS.
• For IL Health Plan only: Must reside in IL or within a reasonable driving distance to assigned providers.

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.
• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees