Health Care Quality Practice Advisor

Centene Corporation

Full Time
Dallas, TX
Posted 2 weeks ago

Position Purpose: Establishes and fosters a healthy working relationship
between large physician practices, IPAs and Centene. Educates providers and
supports provider practice sites regarding the National Committee for Quality
Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for
HEDIS measures, appropriate medical record documentation and appropriate
coding. Assists in resolving deficiencies impacting plan compliance to meet
State and Federal standards for HEDIS and documentation standards. Acts as a
resource for the health plan peers on HEDIS measures, appropriate medical
record documentation and appropriate coding. Supports the development and
implementation of quality improvement interventions and audits in relation to
plan providers.

* Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements
* Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
* Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
* Identifies specific practice needs where Centene can provide support.
* Develops, enhances and maintains provider clinical relationship across product lines.
* Other duties as assigned.

Education/Experience:
Bachelor’s degree or equivalent required. 3+ years of experience in HEDIS
record collection and risk adjustment (coding)

License/Certification:
One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN,
APRN, HCQM, CHP, CPHQ.

Centene is an equal opportunity employer that is committed to diversity, and
values the ways in which we are different. All qualified applicants will
receive consideration for employment without regard to race, color, religion,
sex, sexual orientation, gender identity, national origin, disability, veteran
status, or other characteristic protected by applicable law.

Job Features

Job CategoryQuality Control