Quality Practice Advisor

Centene
Ohio
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Quality & Regulatory (Non-Software)Education: bachelorsSkills: ["Communication","Coaching","Data analysis","Problem-solving"]

Partner with large physician practices and IPAs to improve HEDIS performance and risk adjustment quality. Educate providers on NCQA HEDIS measures, documentation standards, and ICD-9/10 CPT coding, and help resolve deficiencies impacting state and federal compliance. Analyze provider quality and risk adjustment performance data to coach on gap closure, maintain HEDIS abstraction accuracy KPI standards, and support quality improvement interventions and audits.

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FursaFursa
Centene
Centene
3 days ago

Quality Practice Advisor

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Last checked: 4 hours agoStatus: Live

Job Summary

Partner with large physician practices and IPAs to improve HEDIS performance and risk adjustment quality. Educate providers on NCQA HEDIS measures, documentation standards, and ICD-9/10 CPT coding, and help resolve deficiencies impacting state and federal compliance. Analyze provider quality and risk adjustment performance data to coach on gap closure, maintain HEDIS abstraction accuracy KPI standards, and support quality improvement interventions and audits.
Location: Ohio
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Establish and foster relationships with physician practices and IPAs to educate providers on HEDIS measures, documentation guidelines, and ICD-9/10 CPT coding.
  • •Support plan compliance by resolving deficiencies impacting HEDIS and medical record documentation standards.
  • •Collect, summarize, trend, and deliver provider quality and risk adjustment performance data to identify improvement opportunities and coach on gap closure.
  • •Collaborate with Provider Relations and provider-facing teams to improve performance in Quality, Risk Adjustment, and Operations.
  • •Maintain HEDIS abstraction accuracy and quality KPIs, and support quality improvement interventions and audits.
Travel: High travel

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly
Perks:Health Insurance401kPaid Leave

Key Requirements

  • •3+ years of HEDIS record collection and risk adjustment (coding) experience.
  • •Bachelor's degree or equivalent required.
  • •Intermediate to advanced Excel and healthcare reporting skills preferred.
  • •Experience with managed care or health insurance preferred.
  • •Experience interacting with provider groups and applying process improvement/QI methodologies preferred.
Experience:HealthcareManaged careHealth insurance
Education:Bachelor's
Skills:CommunicationCoachingData analysisProblem-solving
Licenses:Valid drivers' license
Tech Stack:NCQAHEDISHEDIS ICD-9/10CPTExcelRisk adjustmentIHI modelLean six sigmaQI science

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