Meridian of Illinois · 10 hours ago
Quality Practice Advisor
Illinois, United States
Full-time
Onsite
Mid Level
$27.02/hr - $48.55/hr
3+ years expCentene is a diversified national organization transforming the health of communities. The Quality Practice Advisor establishes relationships with physician practices, educates them on HEDIS measures, and supports compliance with documentation standards while assisting in quality improvement interventions.
Hospital & Health Care
No H1B
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
Required
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Candidate must reside in IL (Cook, Dupage, Will, Lake Counties) or within a reasonable driving distance as travel required up to 75% to assigned providers
The ideal candidate will have HEDIS measures experience
Strong verbal and written communication skills
Basic Excel skills
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
Registered Health Information Technician (RHIT®)
Preferred
RN or LVN license highly preferred
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Company
Meridian of Illinois
As a Medicaid MCO, Meridian of Illinois provides healthcare to beneficiaries enrolled in the Family Health Plan and Integrated Care Program through a contract with the Illinois Department of Healthcare and Family Services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Daniel Rich
Plan Chief Operating Officer
Company data provided by crunchbase