Risk Adjustment Provider Educator

7 days ago


Pocatello, Idaho, United States Cambia Health Full time
About the Role

Cambia Health 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 healthcare providers in achieving optimal risk adjustment outcomes.

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 closely with key leaders within provider organizations to engage and drive successful performance of provider engagement.
  • 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 of 4 years in a HCC Coding Audit or Network Management role.
  • Equivalent combination of education and experience.
  • CRC credentials are a must.
Preferred Qualifications
  • Risk Adjustment Experience (MUST HAVE).
  • Risk Coding - CRC Certification (MUST HAVE).
  • Network Contracts experience.
  • Value-Based Arrangements.
  • Medical Advantage Knowledge.
What We Offer
  • A competitive salary range of $77k - $127k annually, depending on skills, experience, education, and performance history.
  • A bonus target of 10%.
  • A comprehensive benefits package.
  • Opportunities for career growth and professional development.


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