Provider Engagement Consultant

BlueCross BlueShield of Vermont•Berlin, VT

6d•$67,000 - $75,000•Hybrid

About The Position

Blue Cross and Blue Shield of Vermont is hiring a Provider Engagement Consultant to join its Risk Adjustment team. The role serves as a consultative resource and subject matter expert for providers on Qualified Health Plan Risk Adjustment, helping practices improve documentation, coding, and member care processes. The position is hybrid for employees within driving distance of the Berlin, Vermont office, with required onsite attendance on Wednesdays and flexibility to work remotely the rest of the week. Travel is up to 25% of the time. The stated base salary range is $67,000–$75,000. Additional compensation opportunities and incentives will be discussed during the interview process; final base salary depends on factors including skills, competencies, education, experience, and internal equity. Blue Cross VT describes its culture as focused on members and service, with an inclusive environment and a commitment to the health of Vermonters, outstanding member experiences, and responsible cost management.

Requirements

Bachelor’s degree, or an equivalent combination of education and experience.
At least two years of clinical practice experience in a provider’s office, hospital setting, health plan, or comparable environment.
Direct experience working with providers and/or in a provider’s office.
Advanced oral, verbal, written, and presentation skills.
Strong presence and engagement skills in person, online, and by telephone.
Advanced ability to read and comprehend clinical text in medical records with attention to detail.

Nice To Haves

Experience in provider engagement or performance programs.
Experience with clinical documentation.
Formal coding certification from the American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA).

Responsibilities

Serve as the primary point of contact, consultative resource, and subject matter expert for providers regarding Qualified Health Plan Risk Adjustment.
Educate practitioners and office staff on Risk Adjustment processes and best practices.
Meet regularly with internal and external stakeholders and leaders to review provider performance and formulate tactics for continuous improvement.
Educate practices on accurately depicting members’ health status through accurate provider-level documentation and coding so the plan’s risk score is as accurate as possible.
Share gap reports with provider offices and internal partners as necessary.
Collaborate with provider offices and internal partners using existing resources to address gap-closure barriers and promote documentation and coding best practices.
Work with provider groups and staff to close gaps and help ensure members are seen in offices yearly.
Engage primarily through personal contact with the provider community and travel up to 25% of the time.