Quality Practice Advisor - #9754664
Jobs for Humanity
Company Name: Centene Medicare
Are you ready to make a positive impact on the lives of our 28 million members? Centene is dedicated to improving the health of our communities, one person at a time. We are a national organization that values diversity and offers competitive benefits, including flexible work options. Join us in our mission to transform healthcare.
** This position is a combination of remote work and local travel within Vermont (approximately 25% travel) **
Job Description: In this role, you will build strong relationships with large physician practices, IPAs, and Centene. Your main responsibilities will include educating providers on National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment, providing guidance on medical record documentation and coding, and assisting in resolving deficiencies for plan compliance. Additionally, you will serve as a resource for your peers and support the development of quality improvement interventions and audits.
- Deliver education and guidance on HEDIS measures, medical record documentation, and coding to provider practices and IPAs to meet state, federal, and NCQA requirements.
- Analyze provider quality and risk adjustment performance data to identify opportunities for improvement and provide coaching.
- Collaborate with Provider Relations and other teams to enhance provider performance in quality, risk adjustment, and operations.
- Identify areas where Centene can provide additional support to practices.
- Develop and maintain positive relationships with providers across different products.
Requirements: You must have a bachelor's degree or equivalent and at least 3 years of experience in HEDIS record collection and risk adjustment (coding). You should also possess one of the following certifications: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, or CPHQ.
Our Benefits Package: We offer flexible work solutions, competitive pay, paid time off (including holidays), health insurance coverage for you and your dependents, 401(k) and stock purchase plans, and opportunities for tuition reimbursement and professional development.
Centene is proud to be an equal opportunity employer that values diversity and appreciates the unique qualities individuals bring. We recruit, employ, train, compensate, and promote regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected status.