Provider Engagement Specialist I/II

Blue Cross of Idaho•Meridian, ID

1d•Hybrid

About The Position

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. This role is located in Northern Idaho and will be servicing the provider offices in that region.

Requirements

Level I: 2/+ years’ provider service, coding, or health industry experience
Level II: 4/+ years’ provider service, coding, or health industry experience
Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)
Must hold: Certified Professional Coder Certification (CPC) or Clinical Certification/Clinical License (MA or above)
Certified Risk Coder Certification, or must obtain within one year of date of hire

Responsibilities

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.