Risk Adjustment Provider Educator
1 month ago
At Cambia Health Solutions, we are 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.
About the RoleThis is a unique opportunity to work with a purpose-driven organization that is dedicated to making healthcare easier and lives better. As a Risk Adjustment Provider Educator, you will be responsible for:
- Developing and coordinating risk adjustment education initiatives with network providers
- Acting as the primary point of contact for assigned key provider engagements across Commercial and Medicare lines of business
- Coordinating outreach, communication, training, and education for providers identified through operational reporting channels
- Working with key leaders within provider organizations to engage and drive successful performance of provider engagements
- Assisting senior leadership with special projects related to advancing Cambia's value-based and innovative provider relationships
- Participating in the definition of project deliverables, providing consultation, recommendations, and solutions, reviewing project mandates and directives to determine overall provider engagement approach
- Leading the design and implementation of initiative-related administrative policies and procedures and providing guidance and direction to the work team
To be successful in this role, you will need:
- Bachelor's degree in a related field
- Minimum 5 years of Medicare Advantage or Commercial risk adjustment experience, including a minimum of 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, 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 healthcare 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
As a Risk Adjustment Provider Educator at Cambia Health Solutions, you can expect:
- A competitive salary and generous benefits package
- Opportunities for career growth and professional development
- A collaborative and supportive work environment
- Flexible work arrangements, including the option to work from home
- A comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan with a significant company match
Cambia Health Solutions is a purpose-driven organization that is dedicated to making healthcare easier and lives better. We believe in the importance of building strong relationships with our employees, providers, and members, and we are committed to creating a culture of trust, innovation, and collaboration. If you are passionate about healthcare and want to be part of a team that is making a difference, we encourage you to apply for this exciting opportunity.
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