Risk Adjustment Provider Engagement Specialis
About the position
The Provider Engagement Specialist plays a critical role in developing strategic and operational plans within the Risk Adjustment department. This position focuses on enhancing provider engagement and performance through collaboration with network and value-based care teams. The specialist will monitor physician behavior, provide guidance on Risk Adjustment requirements, and support internal decision-making processes. The role requires leveraging analytics to create effective engagement strategies for Horizon's provider partners.
Responsibilities
- Develop and implement network engagement strategies focused on improving Risk Adjustment coding and documentation.
- Analyze provider-related coding practices and data to recommend actions that enhance understanding of proper coding and documentation practices.
- Create educational materials and conduct training sessions for internal staff on key Risk Adjustment initiatives.
- Monitor and report trends, concerns, and opportunities identified through medical chart and claims reviews.
- Collaborate in developing educational materials for providers and their staff regarding risk adjustment.
- Maintain relationships with key stakeholders within Horizon and the provider community to gather feedback and strategic insights.
- Communicate with the Physician Relations team to troubleshoot complex Risk Adjustment inquiries.
Requirements
- Bachelor's degree preferred in Business, Marketing, Communications, Healthcare Administration, or equivalent work experience.
- Minimum of 5 years healthcare experience with provider or client interaction, including at least 1 year in a Lead Associate role.
- Knowledge of healthcare consulting and prior Risk Adjustment experience is a plus.
- Experience working with clinicians and billing/coding staff is beneficial.
- Proficient in organizing meetings and developing materials for small to medium audiences.
- Understanding of the healthcare industry, including payors and providers.
Nice-to-haves
- Knowledge of the New Jersey physician community is preferred.
- CPC/CRC certification is a plus.
- Experience facilitating meetings for various audiences, including clinicians and senior executives.
Benefits
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
