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For Companies At a Glance
- Tasks: Educate providers on HEDIS measures and improve healthcare quality.
- Company: Join Centene, a leader in transforming community health for 28 million members.
- Benefits: Enjoy competitive pay, flexible work options, and tuition reimbursement.
- Why this job: Make a real impact in healthcare while developing valuable skills in a supportive environment.
- Qualifications: Bachelor's degree and 3+ years in HEDIS record collection required.
- Other info: Travel up to 75% to provider offices; diverse and inclusive workplace.
Overview
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.
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.
Responsibilities
- 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 75% 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
Licenses/Certifications
One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS
Compensation
Pay Range: $26.50 – $47.59 per hour
Benefits and Workplace
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Equal Opportunity
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
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Quality Practice Advisor employer: Cenetene Corporation
Contact Detail:
Cenetene Corporation Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Quality Practice Advisor
✨Tip Number 1
Familiarise yourself with HEDIS measures and NCQA standards. Understanding these guidelines will not only help you in interviews but also demonstrate your commitment to quality improvement in healthcare.
✨Tip Number 2
Network with professionals in the healthcare quality field. Attend relevant conferences or webinars where you can meet people who work in similar roles, as they might provide insights or even referrals for the Quality Practice Advisor position.
✨Tip Number 3
Prepare to discuss specific examples of how you've improved provider performance in past roles. Being able to articulate your experience with data collection and risk adjustment will set you apart from other candidates.
✨Tip Number 4
Research Centene's mission and values thoroughly. Tailoring your conversation to align with their goals of transforming community health will show that you're genuinely interested in contributing to their vision.
We think you need these skills to ace Quality Practice Advisor
Some tips for your application 🫡
Understand the Role: Take the time to thoroughly read the job description for the Quality Practice Advisor position. Understand the key responsibilities and required qualifications, especially around HEDIS measures and risk adjustment.
Tailor Your CV: Customise your CV to highlight relevant experience in HEDIS record collection and risk adjustment. Make sure to include specific examples of how you've educated providers or improved quality metrics in previous roles.
Craft a Compelling Cover Letter: Write a cover letter that not only outlines your qualifications but also demonstrates your passion for improving healthcare quality. Mention how your background aligns with Centene's mission to transform health in communities.
Highlight Relevant Certifications: Ensure you clearly list any relevant certifications such as CCS, LPN, or RN in your application. These credentials are crucial for this role and should be prominently featured to catch the employer's attention.
How to prepare for a job interview at Cenetene Corporation
✨Understand HEDIS Measures
Make sure you have a solid grasp of HEDIS measures and their importance in healthcare quality. Be prepared to discuss how you've applied this knowledge in previous roles, as it will show your expertise and commitment to quality improvement.
✨Showcase Your Communication Skills
As a Quality Practice Advisor, you'll need to educate providers effectively. During the interview, demonstrate your ability to communicate complex information clearly and concisely. Use examples from your past experiences where you've successfully trained or advised others.
✨Highlight Collaborative Experiences
Collaboration is key in this role. Be ready to share instances where you've worked with cross-functional teams, such as Provider Relations or other healthcare professionals, to improve performance. This will illustrate your teamwork skills and ability to drive results.
✨Prepare for Travel Discussion
Since the role requires up to 75% travel, be prepared to discuss your flexibility and willingness to travel. Share any relevant experiences that demonstrate your adaptability and how you manage your time effectively while on the road.
