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