Quality Practice Advisor
Company: Meridian Illinois
Location: Chicago
Posted on: June 25, 2025
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Job Description:
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.
- 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 This is HYBRID, provider facing
position. Candidates must reside in Madison, Sangamon, St. Clair,
Macoupin, or Jersey counties. 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 For IL Health Plan only: Must reside
in IL or within a reasonable driving distance to assigned
providers. 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
Keywords: Meridian Illinois, Elkhart , Quality Practice Advisor, Healthcare , Chicago, Indiana
