Quality Practice Advisor
Core
Establishes and fosters relationships with physician practices and IPAs to educate on NCQA HEDIS measures and risk adjustment, ensuring compliance with state and federal standards.
Role type
Quality Practice Advisor (Health Plan)
Builds
Provider quality performance and risk adjustment compliance
Domain
Healthcare administration / Health Insurance / Quality Improvement
Deliverable
client delivery
Required skills
HEDIS measures knowledge, medical record documentation, ICD-9/10 CPT coding, risk adjustment, quality improvement interventions, audit support, provider relations, data trend analysis
Preferred skills
Provider experience, health plan experience
Technologies
HEDIS abstraction tools, medical coding systems
Responsibilities
Educate providers on HEDIS measures and coding guidelines; collect and analyze quality and risk adjustment performance data; collaborate with provider-facing teams to improve performance; identify practice needs for support; maintain Quality KPIs and HEDIS abstraction accuracy rates.
Seniority
Mid-level, hands-on IC
