HEDIS- Quality Practice Advisor
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.
Bachelor’s degree or equivalent required. 3+ years of experience in HEDIS record collection and risk adjustment (coding)
One of the following required: CHRR, CMRR, CCS, CRC, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN.
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