Risk Adjustment Provider Engagement Specialist - R2832-6334
About the position
The Provider Engagement Specialist plays a crucial role in fostering and enhancing relationships with healthcare providers to improve the health outcomes of members. This position is responsible for promoting, contributing to, and growing provider relationships through various educational, engagement, and outreach activities. The Specialist will work closely with assigned practices to ensure they are effectively participating in risk adjustment programs, which are essential for the financial and operational success of the organization. The Specialist will have the flexibility to work in a hybrid model, which includes both onsite and remote work options. This flexibility allows for a balance between in-person engagement and the convenience of working from home. However, it is important for the Specialist to be based in either Northern Idaho or Southwestern Idaho to facilitate effective communication and relationship-building with local providers. The role may require travel, typically one week per month for nine months of the year, to visit clinic offices within the assigned region. For fully remote team members, there will be a requirement to visit the main campus in Meridian, Idaho, once a quarter. In this role, the Specialist will develop and conduct training sessions for assigned practices, create and manage educational materials related to risk adjustment, and analyze provider performance reports to identify areas for improvement. The Specialist will also ensure compliance with current risk adjustment regulations and guidelines, and lead performance improvement projects aimed at maximizing provider reimbursements. Additionally, the Specialist will perform medical record reviews and communicate findings to providers, ensuring that all practices are aligned with the organization's goals and standards.
Responsibilities
Develops content and conducts training to assigned practices.
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Influences, develops, and maintains provider education materials related to risk adjustment.
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Manages and coordinates the creation, distribution, and collection of clinical documentation and coding improvement tools.
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Analyzes and interprets provider risk adjustment performance reports.
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Develops and implements plans to meet target performance metrics.
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Interprets and maintains current risk adjustment regulatory rules and guidelines to ensure compliance standards are maintained within internal policies, procedures, and workflows.
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Analyzes reporting or provider education programs to identify opportunities for education and/or enhanced reporting.
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Identifies and leads performance improvement projects that maximize provider value-based reimbursements.
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Performs risk adjustment medical record reviews as a primary coder and communicates findings to providers.
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Develops and implements strategies for implementation of annual CMS proposed process changes and updates related to regulatory risk adjustment requirements (Specialist II).
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Develops and maintains cross-functional business relationships with internal and external partners (Specialist II).
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Drives provider-related process improvements (Specialist II).
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Identifies strategic opportunities within department's risk adjustment processes (Specialist II).
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Conducts quality oversight of risk adjustment medical reviews to identify, validate, and review errors found during chart audits, including RADVs (Specialist II).
Requirements
Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college).
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Must hold Certified Professional Coder Certification (CPC) or Clinical Certification (MA or above).
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Certified Risk Coder Certification, or must obtain within one year of date of hire.
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At Specialist I level, must have 2+ years' provider service, coding, or health industry experience; Specialist II requires 4 years.
Nice-to-haves
Benefits
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