Quality Practice Advisor

Centene
United States
Workplace: HybridFull timeUSD 27.02 - 48.55 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 3+ yearsEducation: bachelorsSkills: ["Communication","Relationship building","Coaching","Collaboration","Data analysis"]

Partner with large physician practices and IPAs to improve HEDIS performance and risk adjustment. Educate providers on NCQA HEDIS measures, medical record documentation, and HEDIS ICD-9/10 CPT coding requirements, and help resolve deficiencies impacting plan compliance. Collect and analyze provider quality and risk adjustment performance data to coach on gap closure. Collaborate with provider-facing teams, maintain HEDIS abstraction accuracy/KPIs, and support quality improvement audits and interventions.

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FursaFursa
Centene
Centene
1 day ago

Quality Practice Advisor

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live
Reposted: similar role first listed 6 months ago

Job Summary

Partner with large physician practices and IPAs to improve HEDIS performance and risk adjustment. Educate providers on NCQA HEDIS measures, medical record documentation, and HEDIS ICD-9/10 CPT coding requirements, and help resolve deficiencies impacting plan compliance. Collect and analyze provider quality and risk adjustment performance data to coach on gap closure. Collaborate with provider-facing teams, maintain HEDIS abstraction accuracy/KPIs, and support quality improvement audits and interventions.
Location: United States
Workplace: Hybrid
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Build and maintain relationships with physician practices and IPAs, educating providers on NCQA HEDIS measures and documentation standards.
  • •Deliver guidance on HEDIS medical record documentation and HEDIS ICD-9/10 CPT coding requirements in line with state, federal, and NCQA rules.
  • •Assist with resolving deficiencies impacting plan compliance to meet HEDIS, documentation, and state/Federal standards.
  • •Collect, summarize, trend, and deliver provider quality and risk adjustment performance data to identify opportunities for provider improvement and gap closure.
  • •Maintain HEDIS abstraction accuracy and quality KPIs, collaborate with provider-facing teams, and support quality improvement audits and interventions.
Travel: Extensive travel

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •Bachelor's degree or equivalent required.
  • •3+ years of HEDIS record collection and risk adjustment (coding) required.
  • •Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future.
  • •Residency in Texas in the Corpus Christi area required.
  • •One of the listed licenses/certifications required (e.g., LVN, RN, CPC, CPC-A, CRC, CPHQ, or related credentials).
Experience:3+ years
Education:Bachelor's
Skills:CommunicationRelationship buildingCoachingCollaborationData analysis
Licenses:LVNRNLPNLCSWLMHC
Certifications:CPCCPC-ACRCCPHQRHIT

Eligibility

Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn