Quality Practice Advisor

Centene
Kentucky
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 3+ yearsEducation: bachelorsSkills: ["Communication","Stakeholder management","Coaching","Data analysis","Process improvement"]

Partner with physician practices and IPAs to improve performance on NCQA HEDIS measures and risk adjustment. Educate providers on HEDIS, medical record documentation, and ICD-9/10 CPT coding, and help resolve documentation and compliance deficiencies. Use provider quality and risk adjustment performance data to coach for gap closure, collaborate with Provider Relations and other teams, maintain HEDIS abstraction accuracy standards, and support quality improvement interventions and audits for plan providers.

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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: 9 hours agoStatus: Live
Reposted: similar role first listed 3 months ago

Job Summary

Partner with physician practices and IPAs to improve performance on NCQA HEDIS measures and risk adjustment. Educate providers on HEDIS, medical record documentation, and ICD-9/10 CPT coding, and help resolve documentation and compliance deficiencies. Use provider quality and risk adjustment performance data to coach for gap closure, collaborate with Provider Relations and other teams, maintain HEDIS abstraction accuracy standards, and support quality improvement interventions and audits for plan providers.
Location: Kentucky
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)

Key Responsibilities

  • •Establish and foster relationships with physician practices and IPAs, educating providers and supporting practice sites on NCQA HEDIS measures and risk adjustment.
  • •Deliver education and guidance on HEDIS measures, medical record documentation guidelines, and HEDIS ICD-9/10 CPT coding per state, federal, and NCQA requirements.
  • •Assist in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation.
  • •Collect, summarize, trend, and deliver provider quality and risk adjustment performance data to identify and coach opportunities for improvement and gap closure.
  • •Collaborate with Provider Relations and other provider-facing teams; develop, enhance, and maintain clinical relationships; maintain Quality KPI and HEDIS abstraction accuracy rates; support quality improvement interventions and audits.
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 in HEDIS record collection and risk adjustment (coding) required.
  • •Hold one of the required licenses/certifications (e.g., RN, LPN, CPC, CPC-A, CCS, CPHQ, HCQM, LVN, APRN, or related listed credentials).
  • •Ability to travel up to 75% of time to provider offices.
  • •Knowledge of NCQA HEDIS measures, medical record documentation, and appropriate ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
Experience:3+ yearsHealthcareHEDISRisk adjustmentMedical coding
Education:Bachelor's
Skills:CommunicationStakeholder managementCoachingData analysisProcess improvement
Licenses:CCSLPNLCSWLMHCLMSWLMFTLVNRNAPRNHCQMCHPCPHQCPCCPC-ACBCS
Certifications:CCSLPNLCSWLMHCLMSWLMFTLVNRNAPRNHCQMCHPCPHQCPCCPC-ACBCSRHIT
Tech Stack:NCQAHEDISRisk adjustmentICD-9ICD-10CPTHEDIS abstractionMedical record documentationCodingRHIT

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