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Superior HealthPlan · 1 day ago

Quality Practice Advisor

Afton, TX

Part-time

Hybrid

Mid Level

$26.50/hr - $47.59/hr

3+ years exp

Superior HealthPlan is a diversified national organization focused on transforming the health of communities. The Quality Practice Advisor establishes and fosters relationships with physician practices and educates them on HEDIS measures and documentation standards, while also supporting quality improvement initiatives.

Health CareMedical

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

Qualification

HEDIS record collectionRisk adjustment codingProvider educationData analysisQuality improvementClinical relationship managementCommunication skillsCollaboration skillsProblem-solving skillsTime managementAdaptabilityAttention to detailTeamwork

Required

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

Preferred

For Superior HealthPlan: license/certification is preferred

Candidate must live in TX. Prefer candidate to live in/around Austin, San Antonio, or Dallas

Benefits

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Company

Superior HealthPlan

Superior HealthPlan is a leading provider of managed health care programs and services for 2 million residents in the State of Texas. It is a sub-organization of Centene.

Founded in 1999

Austin, Texas, USA

1001-5000 employees