Quality Practice Advisor
Core
Establishes and fosters relationships with physician practices and IPAs to educate them on NCQA HEDIS measures, risk adjustment, and appropriate medical record documentation/coding.
Role type
Quality Practice Advisor (Provider Relations)
Builds
Provider performance in Quality, Risk Adjustment, and Operations
Domain
Healthcare / Health Insurance / Quality Measurement
Deliverable
dashboards & analysis
Required skills
HEDIS record collection, risk adjustment coding, medical record documentation guidelines, ICD-9/10 CPT coding, quality improvement interventions, audit support, data trend analysis, provider coaching
Preferred skills
Clinical relationship development, gap closure strategy
Technologies
HEDIS, ICD-9/10, CPT
Responsibilities
Educate providers on HEDIS measures and coding standards, collect and analyze provider quality and risk adjustment performance data, collaborate with Provider Relations to improve provider performance, identify practice needs for support, maintain Quality KPIs and HEDIS Abstraction accuracy rates
Seniority
Mid-level, hands-on IC
