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Quality Practice Advisor
Centene Corporation. Establish and foster healthy working relationships between large physician practices, IPAs, and Centene .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in HEDIS measures, medical record documentation, and risk adjustment coding, while fostering strong relationships with healthcare providers. Capable of analyzing performance data and implementing quality improvement interventions to enhance compliance and operational performance.
Highest-signal resume keywords
HEDIS Record CollectionRisk Adjustment CodingHEDIS ICD-9/10 CPT CodingNCQA ComplianceProvider Relationship Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
HEDIS MeasuresMedical Record DocumentationQuality Improvement InterventionsData AnalysisCoding Guidelines
Soft Skills
Relationship BuildingEducation and TrainingCollaborationProblem Solving
Certifications & Qualifications
CCSLPNLCSWLMHCLMSWLMFTLVNRNAPRNHCQM
Industry Keywords
HEDISNCQAState and Federal ComplianceQuality KPIsProvider Audits
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
- Act as a resource for health plan peers on HEDIS measures, medical record 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
- Identify and strategize on 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
- Travel to provider offices up to 75% of the time
- Perform other duties as assigned
- 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
- Must have reliable transportation
- Must have a valid driver's license
- Must live in the Eastern IA area, including examples such as Iowa City, Cedar Falls, Waterloo, Burlington, or Waverly
- Willingness and ability to travel up to 75% of the time
- Knowledge of HEDIS measures, medical record documentation, HEDIS ICD-9/10 and CPT coding, and NCQA, state, and federal requirements
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Diversity-focused equal opportunity employer