Job Description

Overview

Base pay range: $26.50/hr - $47.59/hr. This is a work-from-home, hybrid remote role (up to 50% travel) that involves meeting virtually and in person with provider groups based in South Carolina to discuss and improve HEDIS performance. Preference will be given to applicants who reside in South Carolina, have a pediatric background, and hold an active RN license. The employer is Centene, serving 28 million members and offering competitive benefits.

Position details

• Department: MED-Quality Improvement
• Business Unit: Absolute Total Care
• Schedule: Mon Fri, 8am 5pm CT
• Territory: Typically no more than 2 hours from residence

Key responsibilities

• Establishes and fosters healthy working relationships between large physician practices, IPAs and Centene.
• Educates providers and supports provider practice sites regarding 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, documentation, and coding.
• Supports development and implementation of quality improvement interventions and audits related to plan providers.

Additional responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding per state, federal, and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data; identifies opportunities for provider improvement and gap closure.
• Collaborates with Provider Relations and other provider-facing teams to improve provider performance in Quality, Risk Adjustment and Operations.
• Identifies specific practice needs where Centene can provide support.
• Develops, enhances and maintains provider clinical relationships across product lines.
• Maintains Quality KPI and HEDIS abstraction accuracy rates per corporate standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned and complies with all policies and standards.

Education and experience

• Bachelor's Degree or equivalent required
• 3+ years in HEDIS record collection and risk adjustment (coding) required

Licenses and certifications

• 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)

Pay and benefits

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 schedules. Total compensation may include incentives and may vary based on individual factors and status.

Equal opportunity

Centene is an equal opportunity employer committed to diversity. 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 protected characteristic. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Seniority level

• Not Applicable

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care
• Insurance

Job Tags

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