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.

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

Required Experience: 2/+ years’ provider service, coding, or health industry experience

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/Clinical License (MA or above)
• Certified Risk Coder Certification, or must obtain within one year of date of hire

Travel: Typically 2-3 days a week twice a month to clinic offices in Northern Idaho. Travel to Blue Cross of Idaho's main campus in Meridian, Idaho (once per quarter).

• 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.

As of the date of this posting, a good faith estimate of the current pay range is $64,893 to $90,850. The position is eligible for an annual incentive bonus (variable depending on company and employee performance.

The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

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.