Associate Quality Practice Advisor

Centene
Pennsylvania
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 1+ yearsEducation: bachelorsSkills: ["Communication","Coaching","Data analysis","Documentation","Stakeholder management"]

Establish and foster relationships with community physician and small provider practices and WellCare to improve HEDIS performance. Educate providers on NCQA HEDIS measures, documentation guidelines, and ICD-9/10 CPT coding, then help resolve deficiencies impacting plan compliance. Collect and trend provider performance data, coach gap-closing opportunities, coordinate with Provider Relations, document visit outcomes and action plans, and support HEDIS quality improvement and program studies.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Centene
Centene
1 day ago

Associate Quality Practice Advisor

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Establish and foster relationships with community physician and small provider practices and WellCare to improve HEDIS performance. Educate providers on NCQA HEDIS measures, documentation guidelines, and ICD-9/10 CPT coding, then help resolve deficiencies impacting plan compliance. Collect and trend provider performance data, coach gap-closing opportunities, coordinate with Provider Relations, document visit outcomes and action plans, and support HEDIS quality improvement and program studies.
Location: Pennsylvania
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Entry level

Key Responsibilities

  • •Educate community physician and small provider practices on appropriate HEDIS measures, medical record documentation guidelines, and NCQA-aligned ICD-9/10 CPT coding.
  • •Collect, summarize, and trend provider performance data to identify and strategize opportunities for provider improvement.
  • •Collaborate with Provider Relations to improve provider performance in quality, risk adjustment, and operations (claims and encounters).
  • •Assist in delivering provider-specific metrics and coaching providers on gap-closing opportunities, including identifying practice needs for WellCare support.
  • •Document action plans and visit outcomes, report critical incidents related to quality of care, and ensure documentation and regulatory report content are accurate and meet deadlines.
Travel: Extensive travel

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •1+ year of experience in related HEDIS medical record review or quality improvement with data/chart review to consult and educate providers (or 2 years medical coding or transferable experience).
  • •Bachelor’s degree in healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work, or related field (or equivalent work experience in a managed care environment related to HEDIS record review, quality improvement, or medical coding).
  • •Must live in the Central PA area and have reliable transportation with a valid driver’s license.
  • •Preferred: Master’s degree in a related field.
  • •Preferred license/certifications including Certified Coding Specialist (CCS) or nursing/behavioral health credentials (e.g., RN, LPN, LCSW) and/or quality certifications (HCQM, CHP, CPHQ).
Experience:1+ yearsHealthcareManaged careQuality improvementMedical coding
Education:Bachelor's
Skills:CommunicationCoachingData analysisDocumentationStakeholder management
Licenses:Licensed Practical Nurse (LPN)Licensed Master Social Work (LMSW)Licensed Vocational Nurse (LVN)Licensed Mental Health Counselor (LMHC)Licensed Marital and Family Therapist (LMFT)Licensed Certified Social Worker (LCSW)Licensed Registered Nurse (RN)Acute Care Nurse Practitioner (APRN) (ACNP-BC)Other Foreign trained physician/MD
Certifications:Certified Coding Specialist (CCS)Health Care Quality and Management (HCQM)Certified Healthcare Professional (CHP)Certified Professional in Healthcare Quality (CPHQ)
Tech Stack:NCQAHEDISICD-9ICD-10CPTMedical record documentationMedical codingChart reviewsProvider performance data

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