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Centene Corporation · 1 day ago

Associate Quality Practice Advisor

Kansas, United States

Full-time

Hybrid

Entry Level

$26.50/hr - $47.59/hr

1+ years exp

Centene Corporation is transforming the health of communities, one person at a time. The Associate Quality Practice Advisor will establish relationships with community physicians and provider practices, educate them on HEDIS measures, and assist in improving provider performance to meet compliance standards.

Hospital & Health Care

Responsibilities

Establishes and fosters a healthy working relationship between community physician and small provider practices and WellCare

Educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures

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

Under general guidance form Senior Quality Practice Advisors and management, educates community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements

Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement

Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)

Assists in delivering provider specific metrics and coaches providers on gap closing opportunities

Assists in identifying specific practice needs where WellCare can provide support

Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education

Provides resources and educational opportunities to provider and staff

Captures concerns and issues in action plans as agreed upon with provider

Documents action plans and details of visits and outcomes

Reports critical incidents and information regarding quality of care issues

Communicates with external data sources as needed to gather data necessary to measure identified outcomes

Provides communication such as newsletter articles, member education, outreach interventions and provider education

Supports quality improvement HEDIS and program studies as needed, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history

Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements

Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline

Enter documentation of findings in identified databases and ensure accuracy in medical records for data collection, DE and reporting

Performs other duties as assigned

Complies with all policies and standards

Qualification

HEDIS knowledgeData interpretationMedical codingQuality improvementProvider performanceCommunication skillsCollaboration skillsProblem-solving skills

Required

A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role

1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff OR 2 years medical coding or other transferable experience and skill set combination that demonstrates the ability to learn and perform the level of the position

HEDIS knowledge and Data interpretation

Provider performance

Preferred

A Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field

A license in one of the following: Certified Coding Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Licensed Vocational Nurse (LVN), Licensed Mental Health Counselor (LMHC), Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse (RN), Acute Care Nurse Practitioner (APRN) (ACNP-BC), Other Foreign trained physician/MD, Health Care Quality and Management (HCQM), Certified Healthcare Professional (CHP), Certified Professional in Healthcare Quality (CPHQ)