Quality Practice Advisor

Centene Corporation

. Establish and foster healthy working relationships between large physician practices, IPAs and Centene .

Posted 10/5/2026full-timeRemote • Kentucky • United StatesMid-LevelSenior💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in HEDIS measures, risk adjustment coding, and provider education, while fostering strong relationships with healthcare providers to enhance quality improvement and compliance. Proficient in analyzing performance data to identify opportunities for provider improvement and ensuring adherence to documentation standards.

Highest-signal resume keywords

HEDIS Record CollectionRisk Adjustment CodingProvider EducationQuality Improvement InterventionsHealthcare Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

HEDIS MeasuresICD-9 CodingICD-10 CodingCPT CodingMedical Record DocumentationData AnalysisQuality KPI MaintenanceDocumentation StandardsProvider AuditsGap-Closure Identification

Soft Skills

Relationship BuildingCollaborationCommunicationProblem SolvingAdvising

Certifications & Qualifications

CCSLPNLCSWLMHCLMSWLMFTLVNRNAPRNHCQM

Industry Keywords

NCQAHEDISRisk AdjustmentState ComplianceFederal ComplianceProvider RelationsQuality ImprovementHealthcare StandardsClinical RelationshipsProvider Practices

About the role

Key responsibilities & impact

Establish and foster healthy working relationships between large physician practices, IPAs and Centene
Educate providers and support provider practice sites regarding NCQA HEDIS measures and risk adjustment
Provide education on HEDIS measures, medical record documentation and appropriate coding
Assist in resolving deficiencies affecting plan 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 provider-related audits
Deliver, advise and educate provider practices and IPAs on HEDIS measures, documentation guidelines and HEDIS ICD-9/10 CPT coding
Collect, summarize, trend and deliver provider quality and risk adjustment performance data to identify provider improvement and gap-closure opportunities
Collaborate with Provider Relations and other provider-facing teams to improve Quality, Risk Adjustment and Operations performance
Identify 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 according to corporate standards
Perform other duties as assigned and comply with all policies and standards

Requirements

What you’ll need

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
RHIT®: state requirements apply for positions aligned to a corporate line of business operating within a state-specific health plan
Ability to travel 50% or more; up to 75% of time to provider offices
For the Kentucky plan only, listed licenses/certifications are preferred but not required, with 3 years of HEDIS experience

Benefits

Comp & perks

Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation