Quality Practice Advisor

Centene
Iowa
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 3+ yearsEducation: bachelorsSkills: []

Establish and maintain relationships with physician practices and IPAs to improve HEDIS performance and risk adjustment. Educate providers on NCQA HEDIS measures, documentation standards, and ICD-9/10 CPT coding requirements, and help resolve deficiencies affecting plan compliance. Analyze and deliver provider quality and risk adjustment data, partner with provider-facing teams to coach improvements, and support quality improvement interventions and audits for participating practices.

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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

Job Summary

Establish and maintain relationships with physician practices and IPAs to improve HEDIS performance and risk adjustment. Educate providers on NCQA HEDIS measures, documentation standards, and ICD-9/10 CPT coding requirements, and help resolve deficiencies affecting plan compliance. Analyze and deliver provider quality and risk adjustment data, partner with provider-facing teams to coach improvements, and support quality improvement interventions and audits for participating practices.
Location: Iowa
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Develop healthy working relationships with large physician practices and IPAs and serve as a resource for health plan peers on HEDIS, documentation, and coding.
  • •Deliver education and guidance to provider practices and IPAs on HEDIS measures and documentation standards per NCQA, state, and federal requirements.
  • •Collect, summarize, trend, and deliver provider quality and risk adjustment performance data to identify opportunities and coach gap closure.
  • •Collaborate with Provider Relations and other provider-facing teams to improve performance across Quality, Risk Adjustment, and Operations.
  • •Support quality improvement interventions and audits related to plan providers, including assisting in resolving deficiencies impacting plan compliance.
Travel: High travel

Pay and Benefits

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

Key Requirements

  • •3+ years of HEDIS record collection and risk adjustment (coding) experience.
  • •Bachelor's Degree (or equivalent) required.
  • •Educate and support provider practices and IPAs on NCQA HEDIS measures, medical record documentation guidelines, and HEDIS ICD-9/10 CPT coding.
  • •Maintain HEDIS abstraction accuracy and quality KPI standards as per corporate requirements.
  • •Must have reliable transportation, a valid driver's license, and live in the Central or Southeastern IA area; willing to travel up to 75%.
Experience:3+ years
Education:Bachelor's
Certifications:CCSLPNLCSWLMHCLMSWLMFTLVNRNAPRNHCQMCHPCPHQCPCCPC-ACBCS

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