Quality Practice Advisor
Core
Establishes and fosters healthy working relationships with large physician practices and IPAs to support NCQA HEDIS measures and risk adjustment.
Role type
Quality Practice Advisor (Health Plan)
Builds
Provider quality performance data, quality improvement interventions, and audit support for plan providers.
Domain
Healthcare / Managed Care / Health Insurance
Deliverable
dashboards & analysis
Required skills
HEDIS record collection, risk adjustment coding, medical record documentation, coding, provider relations, quality improvement interventions, audits, data trend analysis, gap closure strategy
Preferred skills
Excel, healthcare reporting, managed care experience, health insurance experience, provider group interaction, QI science methodologies (IHI model, lean six sigma)
Technologies
Excel
Responsibilities
Educate providers on HEDIS measures and documentation standards, assist in resolving compliance deficiencies, collect and summarize provider quality performance data, collaborate with Provider Relations teams, develop clinical relationships across product lines, travel to provider offices
Seniority
Mid-level, hands-on IC
