Quality Practice Advisor
Core
Educates physician practices and IPAs on NCQA HEDIS measures, medical record documentation, and coding to ensure plan compliance and quality improvement.
Role type
Senior IC Quality Practice Advisor (Health Plan)
Builds
Provider quality performance and risk adjustment compliance
Domain
Healthcare administration / Health Plan Operations
Deliverable
dashboards & analysis
Required skills
HEDIS measure expertise, medical record documentation, ICD-9/10 and CPT coding, risk adjustment, data trend analysis, provider coaching, quality KPI management
Preferred skills
LVN, RN, CPC, CPC-A, CRC, CPHQ
Technologies
HEDIS abstraction tools, claims and encounter data systems
Responsibilities
Deliver education on HEDIS measures and coding guidelines to provider practices; Collect and analyze quality and risk adjustment performance data; Collaborate with provider relations teams to improve performance; Identify practice needs for support; Maintain clinical relationships across product lines; Ensure HEDIS abstraction accuracy rates meet corporate standards
Seniority
Mid-Senior level, hands-on IC
