Risk Adjustment Provider Educator
7 days ago
Cambia Health Solutions is seeking a highly skilled Risk Adjustment Provider Educator to join our team. As a key member of our Risk Adjustment Operations team, you will play a critical role in developing and implementing education initiatives to support network providers in achieving optimal risk adjustment performance.
Key Responsibilities- Develop and coordinate risk adjustment education initiatives with network providers, serving as the primary point of contact for assigned key provider engagements across Commercial and Medicare lines of business.
- Coordinate outreach, communication, training, and education for providers identified through operational reporting channels as candidates for provider education engagement.
- Work with key leaders within provider organizations to engage and drive successful performance of provider engagements.
- Assist senior leadership with special projects related to advancing Cambia's value-based and innovative provider relationships.
- Participate in defining project deliverables, providing consultation, recommendations, and solutions, reviewing project mandates and directives to determine overall provider engagement approach.
- Lead, under the direction of management, in designing and implementing initiative-related administrative policies and procedures, providing guidance and direction to the work team.
- Bachelor's degree in a related field.
- Minimum 5 years of Medicare Advantage or Commercial risk adjustment experience, including a minimum 4 years of experience in a HCC Coding Audit or Network Management role.
- Equivalent combination of education and experience.
- CRC credentials are a must.
- Strong consulting, communication (written and verbal), influencing, and facilitation skills.
- Proficiency in using Microsoft Office tools and proven ability to display analytical data and research findings for effective presentations and improved decision making.
- Knowledge of health care industry trends, provider relations, and risk adjustment HCC coding, ICD10 diagnosis coding.
- Knowledge of health insurance, including medical and dental terminology, procedural and diagnosis coding, reimbursement methodologies, and various provider network arrangements.
- A competitive salary and generous benefits package.
- Opportunities for career growth and professional development.
- A collaborative and supportive work environment.
- A comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan with a significant company match.
- Up to 12 weeks of paid parental time off.
- Award-winning wellness programs and employee assistance fund.
- Commuter and parking benefits.
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Provider Education Specialist in Risk Adjustment
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Provider Education Specialist in Risk Adjustment
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Salt Lake, Utah, United States Cambia Health Solutions Full timeProvider Education Specialist in Risk AdjustmentRemote work opportunity available for candidates in Oregon, Washington, Idaho, or Utah (Preference for WA)Join our mission to create a patient-focused and financially viable healthcare system.Who We Are Looking For:At Cambia, our dedicated Risk Adjustment Operations team is committed to streamlining healthcare...
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Salt Lake, Utah, United States Cambia Health Solutions Full timeAbout the RoleCambia Health Solutions is seeking a highly skilled Risk Adjustment Provider Educator to join our team. As a key member of our Risk Adjustment Operations team, you will play a critical role in developing and implementing education initiatives to support network providers in achieving optimal risk adjustment performance.Key...
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