Quality Practice Advisor

Centene
North Carolina
Workplace: HybridFull timeUSD 27.02 - 48.55 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 3+ yearsEducation: bachelorsSkills: ["Relationship building","Provider education","Documentation review","Coaching","Collaboration"]

Build and maintain provider relationships across large physician practices, IPAs, and Centene. Educate provider practices on NCQA HEDIS measures, medical record documentation, and appropriate ICD-9/10 CPT coding to improve plan compliance. Identify and coach on quality and risk adjustment performance using provider data, resolve deficiencies, and support quality improvement interventions and audits. Hybrid field-based role traveling up to 75%.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Centene
Centene
1 day ago

Quality Practice Advisor

āœ“ Verified Job

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live
Reposted: similar role first listed 4 months ago

Job Summary

Build and maintain provider relationships across large physician practices, IPAs, and Centene. Educate provider practices on NCQA HEDIS measures, medical record documentation, and appropriate ICD-9/10 CPT coding to improve plan compliance. Identify and coach on quality and risk adjustment performance using provider data, resolve deficiencies, and support quality improvement interventions and audits. Hybrid field-based role traveling up to 75%.
Location: North Carolina
Workplace: Hybrid
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • ā€¢Establishes and fosters relationships with large physician practices and IPAs, serving as a resource on HEDIS measures, documentation, and coding.
  • ā€¢Delivers education to provider practices and IPAs on HEDIS measures and medical record documentation guidelines, including appropriate HEDIS ICD-9/10 CPT coding.
  • ā€¢Assists in resolving deficiencies impacting plan compliance to meet state and federal HEDIS and documentation standards.
  • ā€¢Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify opportunities for provider improvement.
  • ā€¢Supports the development and implementation of quality improvement interventions and audits, with travel up to 75% to provider offices.
Travel: Extensive travel

Pay and Benefits

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

Key Requirements

  • ā€¢Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future.
  • ā€¢Bachelor's degree or equivalent required.
  • ā€¢3+ years in HEDIS record collection and risk adjustment (coding) required.
  • ā€¢Reside in North Carolina in one of the specified counties.
  • ā€¢One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS. RN licensure highly preferred.
Experience:3+ years
Education:Bachelor's
Skills:Relationship buildingProvider educationDocumentation reviewCoachingCollaboration
Licenses:CCSLPNLCSWLMHCLMSWLMFTLVNRNAPRNHCQMCHPCPHQCPCCPC-ACBCS
Certifications:RHITĀ®
Tech Stack:NCQA HEDISHEDISICD-9ICD-10CPTRisk adjustment

Eligibility

Visa:H-1BL-1O-1H-1B1F-1J-1OPTCPT
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