Provider Engagement Specialist I/II

This role is located in Northern Idaho and will service provider offices in that region.

Responsibilities

• Develops content and conducts training for 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.

Requirements

• Bachelor’s Degree or equivalent work experience (two years’ relevant work experience is equivalent to one year of college).
• Certified Professional Coder Certification (CPC) or Clinical Certification/Clinical License (MA or above) or Certified Risk Coder Certification (must obtain within one year of hire if not already held).
• Experience:
  • Level I: 2+ years’ provider service, coding, or health industry experience.
  • Level II: 4+ years’ provider service, coding, or health industry experience.
• Travel: Typically 2-3 days a week twice a month to clinic offices in Northern Idaho, plus quarterly travel to Blue Cross of Idaho's main campus in Meridian, Idaho.

Pay

Current pay range (as of posting date):

• Level I: $66,353 to $92,894
• Level II: $78,064 to $117,095

The position is eligible for an annual incentive bonus, variable depending on company and employee performance. The pay range considers factors including competencies, education, qualifications, certifications, experience, skills, seniority, performance, travel requirements, internal equity, geography, and business needs.

Benefits

• Paid time off, paid holidays, community service, and self-care days.
• Medical, dental, vision, and 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.
• Paid family leave program.

Benefits adhere to all relevant state and local laws concerning employee leave.