Quality Practice Advisor

Responsibilities

• 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, documentation, and coding
• Support development and implementation of quality improvement interventions and provider-related audits
• Deliver advice and education to 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 and strategize or coach on provider improvement and gap-closure opportunities
• Collaborate with Provider Relations and other provider-facing teams to improve performance in Quality, Risk Adjustment, and Operations
• 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 75% of the time
• Comply with policies and standards and perform other assigned duties

• Bachelor's Degree or equivalent required
• 3+ years in HEDIS record collection and risk adjustment (coding) required
• One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS
• For Managed Health Services - IN, no license/certification is required
• Reliable transportation required
• Valid driver's license and insurance required
• Must be local to the Indianapolis, IN area
• Willingness to travel up to 75% of the time
• Knowledge of NCQA HEDIS measures, risk adjustment, medical record documentation, and ICD-9/10 CPT coding

Demonstrates expertise in HEDIS measures, risk adjustment, and medical record documentation, while effectively educating and collaborating with provider practices to enhance quality and compliance. Proven ability to analyze performance data and implement quality improvement interventions.

• HEDIS Record Collection
• Risk Adjustment Coding
• NCQA HEDIS Measures
• ICD-9/10 CPT Coding
• Quality Improvement Interventions

• HEDIS Record Collection
• Risk Adjustment Coding
• ICD-9/10 CPT Coding
• Medical Record Documentation
• Data Analysis
• Quality KPI Maintenance
• Provider Education
• Documentation Guidelines
• Gap-Closure Strategies
• Provider Audits

• Relationship Building
• Collaboration
• Coaching
• Communication
• Problem Solving

• CCS
• LPN
• LCSW
• LMHC
• LMSW
• LMFT
• LVN
• RN
• APRN
• HCQM

• HEDIS
• NCQA
• Managed Health Services
• Quality Improvement
• Risk Adjustment
• Provider Relations
• Compliance Standards
• Documentation Standards
• Healthcare Quality
• Provider Practices