Risk Adjustment Provider Engagement Specialis

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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
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