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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, risk adjustment coding, and provider education, while fostering strong clinical relationships and ensuring compliance with quality standards. Proficient in data collection and analysis to drive quality improvement initiatives within healthcare settings.
Highest-signal resume keywords
HEDIS Record CollectionRisk Adjustment CodingProvider EducationQuality Improvement InterventionsHealthcare Compliance
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 MeasuresICD-9 CodingICD-10 CodingCPT CodingMedical Record DocumentationData CollectionQuality KPI MaintenanceDocumentation StandardsGap Closure StrategiesProvider Audits
Soft Skills
Relationship BuildingCollaborationCoachingCommunicationProblem Solving
Certifications & Qualifications
CCSLPNLCSWLMHCLMSWLMFTLVNRNAPRNHCQM
Industry Keywords
NCQAHEDISRisk AdjustmentState ComplianceFederal ComplianceQuality ImprovementProvider RelationsHealthcare StandardsClinical RelationshipsTexas Healthcare
About the role
Key responsibilities & impact- Establish and foster healthy working relationships between large physician practices, IPAs and Centene
- Educate providers on NCQA HEDIS measures and risk adjustment
- Support provider practice sites regarding HEDIS measures, medical record documentation and appropriate coding
- Assist in resolving deficiencies impacting plan compliance with State and Federal HEDIS and documentation standards
- Act 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
- Identify and strategize or coach 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
- Comply with all policies and standards
- Perform other duties as assigned
Requirements
What you’ll need- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Must reside in Texas, with preference for East Dallas/Northeast 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
- RHIT®: state requirements apply for positions aligned to a corporate line of business operating within a state-specific health plan
- For Superior HealthPlan: license/certification is preferred
- Ability to travel up to 75% of time to provider offices
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
- Equal opportunity employer committed to diversity