Quality Practice Advisor

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🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Establish and foster healthy working relationships between large physician practices, IPAs and Centene • Educate providers and support provider practice sites regarding NCQA HEDIS measures and risk adjustment • Provide education on HEDIS measures, medical record documentation and appropriate coding • Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS and documentation standards • Serve as a resource for health plan peers on HEDIS measures, medical record documentation and coding • Support development and implementation of quality improvement interventions and provider-related audits • Advise and educate provider practices and IPAs on HEDIS measures, documentation guidelines and HEDIS ICD-9/10 CPT coding • Collect, summarize, trend and deliver provider quality and risk adjustment performance data • Identify opportunities for provider improvement and gap closure; strategize and coach providers • Collaborate with Provider Relations and other provider-facing teams to improve Quality, Risk Adjustment and Operations performance • Identify practice needs where Centene can provide support • Develop, enhance and maintain provider clinical relationships across product lines • Maintain Quality KPIs and HEDIS abstraction accuracy rates according to corporate standards • Travel to provider offices up to 50% of the time • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• Must reside in Ohio • Ability to travel up to 50% of the time to provider offices • Reliable transportation required • Valid driver's license and insurance required • Bachelor's Degree or equivalent required • 3+ years of experience in HEDIS record collection and risk adjustment coding required • Intermediate to advanced Excel skills highly preferred • Healthcare reporting skills highly preferred • Managed care or health insurance experience highly preferred • Preferred experience interacting and working with provider groups • Process improvement knowledge and application using QI science methodologies preferred, such as the IHI model for improvement or Lean Six Sigma • No license/certification is required for Buckeye Health Plan

🏖️ Benefits

• Competitive pay • Health insurance • 401K plans • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation