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.
Requirements
- 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
Benefits
- Competitive pay
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
