Risk Adjustment Provider Educator

7 days ago


Salt Lake, Utah, United States Cambia Health Solutions Full time
About the Role

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.
Requirements
  • 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.
What We Offer
  • 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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