Quality Practice Advisor
Core
Educates and advises physician practices and IPAs on NCQA HEDIS measures, medical record documentation, and risk adjustment coding to ensure plan compliance.
Role type
Quality Practice Advisor (Clinical Quality & Risk Adjustment)
Builds
Provider quality performance and risk adjustment compliance
Domain
Healthcare / Health Insurance / Quality Measurement
Deliverable
dashboards & analysis
Required skills
HEDIS measures expertise, risk adjustment coding, medical record documentation review, ICD-9/10 CPT coding, provider education, data trend analysis, audit support
Preferred skills
None stated
Technologies
None stated
Responsibilities
Deliver education to provider practices on HEDIS and coding guidelines; Collect and analyze provider quality and risk adjustment performance data; Collaborate with Provider Relations to improve quality and operations metrics; Identify practice needs for support; Maintain Quality KPIs and HEDIS abstraction accuracy rates; Travel up to 75% of time to provider offices
Seniority
Mid-level, hands-on IC
