Demo

Quality Practice Advisor

Managed Health Services Indiana
IN Full Time
POSTED ON 4/3/2025
AVAILABLE BEFORE 4/29/2025

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

  • THIS POSITION REQUIRES VISITS UP TO 5 DAYS A WEEK TO PROVIDERS OFFICES IN THE STATE OF INDIANA

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.
  • Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
  • Ability to travel up to 50% of time to provider offices.
  • Performs other duties as assigned
  • Complies with all policies and standards
  • Education / Experience : 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, CBCS required

    Pay Range : $26.50 - $47.59 per hour

    Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

    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.

    Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

    Salary : $27 - $48

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    Job openings at Managed Health Services Indiana

    Managed Health Services Indiana
    Hired Organization Address Indianapolis, IN Full Time
    Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be th...

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