Risk Adjustment Provider Engagement Specialist

The Provider Engagement Specialist promotes, contributes, and grows provider relationships by providing education, engagement, and/or outreach activities. Promotes and enhances relationships with providers to invest in the health of members. Responsible for the overall performance of assigned practices within risk adjustment programs.

The Specialist will have flexibility to work onsite and/or hybrid location (onsite campus + work-from-home); it may potentially have ability to work fully remote from a mutually acceptable location within Idaho or contiguous area to Idaho. The Specialist must be based in either Northern Idaho or Southwestern Idaho ;

Required Education: Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

Required Licenses/Certifications

• Must hold: Certified Professional Coder Certification (CPC) or Clinical Certification (MA or above)
• Certified Risk Coder Certification, or must obtain within one year of date of hire
  
  

Travel: Typically (1) week a month, (9) months of the year, to clinic offices within the Specialist's assigned region. Effort is made to align travel region to the Specialist's general location. Fully remote team members will be required to visit onsite at BCI's main campus in Meridian Idaho (one week per quarter).

Required Experience: at Specialist I, must have 2/+ years’ provider service, coding, or health industry experience; Specialist II requires 4 years.

Your Day May Look Like

• Develops content and conducts training to assigned practices. Influences, develops, and maintains provider education materials related to risk adjustment.
• Manages and coordinates the creation, distribution and collection of clinical documentation and coding improvement tools.
• Analyzes and interprets provider risk adjustment performance reports. Develops and implements plans to meet target performance metrics.
• Interprets and maintains current risk adjustment regulatory rules and guidelines to ensure compliance standards are maintained within internal policies, procedures, and workflows.
• Analyzes reporting or provider education programs to identify opportunities for education and/or enhanced reporting.
• Identifies and leads performance improvement projects that maximize provider value-based reimbursements.
• Performs risk adjustment medical record reviews as a primary coder and communicates findings to providers.
  
  

Specialist II May Also

• Develops and implements strategies for implementation of annual CMS proposed process changes and updates related to regulatory risk adjustment requirements
• Develops and maintains cross-functional business relationships with internal and external partners
• Drives provider-related process improvements
• Identifies strategic opportunities within department’s risk adjustment processes
• Conducts quality oversight of risk adjustment medical reviews to identify, validate and review errors found during chart audits, including RADVs
  
  

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.