HEDIS- Quality Practice Advisor

Remote

Full Time

Entry Level

DRCC is currently seeking a HEDIS Quality Practice Advisor that will Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).

Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment.
Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding.
Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards.
Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding.
Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.
Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.

Education/Experience

Bachelor’s degree or equivalent required. 3+ years of experience in HEDIS record collection and risk adjustment (coding)

License/Certification:

One of the following required: CHRR, CMRR, CCS, CRC, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN.

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Do you hold a professional certification as a Certified Medical Record Reviewer™ (CMRR™) or Certified Healthcare Record Reviewer? (CMRR or CHRR credentials through AIMRRA).* YesNo

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HEDIS- Quality Practice Advisor

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