Quality Improvement Specialist
2 weeks ago
Centene is seeking a Quality Practice Advisor to join our team. As a Quality Practice Advisor, you will play a critical role in establishing and fostering healthy working relationships between large physician practices, IPAs, and Centene. You will educate providers and support provider practice sites regarding National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment.
Key Responsibilities- Deliver Education and Support: Provide education and support to provider practices and IPAs on HEDIS measures, medical record documentation guidelines, and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
- Collect and Analyze Data: Collect, summarize, trend, and deliver provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
- Collaborate with Provider Relations: Collaborate with Provider Relations and other provider-facing teams to improve provider performance in areas of Quality, Risk Adjustment, and Operations (claims and encounters).
- Identify Practice Needs: Identify specific practice needs where Centene can provide support.
- Maintain Quality KPIs: Maintain Quality KPIs and maintain good standing with HEDIS Abstraction accuracy rates as per corporate standards.
- Travel Requirements: Ability to travel up to 75% of time to provider offices.
- Other Duties: Perform other duties as assigned.
- Education: Bachelor's degree or equivalent required.
- Experience: 3+ years of experience in HEDIS record collection and risk adjustment (coding).
- License/Certification: One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS.
- Competitive Pay: $46.68 per hour.
- Comprehensive Benefits Package: Competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules.
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