Sunshine Health · 10 hours ago
Quality Practice Advisor
Florida, United States
Full-time
Onsite
Mid Level
$27.02/hr - $48.55/hr
3+ years expSunshine Health is part of Centene, a national organization transforming the health of communities. The Quality Practice Advisor will establish relationships with physician practices, educate them on HEDIS measures, and support compliance with state and federal standards.
Hospital & Health Care
No H1B
U.S. Citizen Only
Responsibilities
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
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 FL
Travel required up to 35% 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
Preferred
RN or LVN license highly preferred
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
A flexible approach to work with remote, hybrid, field or office work schedules
Company
Sunshine Health
Headquartered in Broward County, Sunshine Health is among the largest healthcare plans in Florida.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Dwanna Hill
Provider Partnership Manager
Katherine Gomez
Provider Partnership Account Manager
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