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Quality Practice Advisor
Centene Corporation. Establish and foster working relationships between large physician practices, IPAs, and Centene .
About the role
Key responsibilities & impact- Establish and foster 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 coding
- Assist in resolving deficiencies affecting plan compliance with state and federal HEDIS and documentation standards
- Serve as a resource for health plan peers
- 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
- 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 standards
- Comply with all policies and standards
- Perform other duties as assigned
Requirements
What you’ll need- Candidates must reside in Nevada
- Bachelor's Degree or equivalent required
- 3+ years in HEDIS record collection and risk adjustment (coding) required
- One active license or certification required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS
- Ability to travel up to 75% of the time to provider offices
- Knowledge of HEDIS measures, medical record documentation, and appropriate coding
- Preferred: provider experience, HEDIS knowledge, medical coding experience, quality improvement experience, and health plan 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