Settings

📁
Provider Relations
📅
15703 Requisition #
Apply for Job
Share this Job
Sign Up for Job Alerts
The Risk Adjustment Provider Educator II engages providers via electronic tools and (regional) face to face visits to promote the concept and understanding of Risk Adjustment (Medicare, Medicaid and Commercial) and value-based provider arrangements including the Collaborative Care Model. They are relied on as coding subject matter expert for the organization and will represent the organization in dealing with vendors, delegated entities and providers.
 
Maintains knowledge of risk adjustment regulatory requirements and serves as an internal resource for departments in implementing coding and process changes needed to meet compliance. Communicates standard and/or ad hoc reporting, status of initiatives and improvement planning to leadership, team and other managers Has complete and thorough understanding of Risk Adjustment program(s) and translates information at multiple audience levels.
 
The incumbent will serve as point of contact for provider(s) and/or group for risk adjustment questions regarding training on coding and program awareness for:
 
Prospective campaigns including risk coding/documentation, HEDIS/STARS metrics, encounter facilitation and Retail Center/In Home Assessments
 
Essential Functions
  • Applies thorough understanding of physician/facility practices and supports practice transformation through education and support to participating groups to improve documentation and ICD-10 coding guidelines. Assists in the development of educational materials, policies and procedures, training programs and educational tools for coding staff, Provider Relations and outside physician offices.
  • Relied on as coding subject matter expert for the organization and will represent the organization in dealing with vendors, delegated entities and providers. Maintains an extensive understanding and knowledge of regulatory compliance for risk adjustment and serves as an internal resource for departments in implementing coding and process changes needed to meet compliance
  • Demonstrated analytical and problem-solving ability regarding barriers to improve accuracy of HCC coding; perform and/or collaborate with internal business stakeholders on analysis of trend issues, cost savings opportunities, utilization patterns, and other analysis as needed on Provider groups.
  • Works in collaboration with key corporate stakeholders to support strategy and infrastructure and capabilities that support RPM initiatives.
  • Works collaboratively with internal business partners to improve provider relationships; Communicates standard and/or ad hoc reporting, status of initiatives and improvement planning to leadership, team and other managers.
  • Accountable for providing recommendations to management for strengthening programs
  • Engages providers at various audience levels via electronic tools and face to face encounters (group and/or one-on-one session) to promote the concept and understanding of Risk Adjustment (Medicare, Medicaid and Commercial) under various value-based arrangements.
  • Responsible for developing HCC specific provider improvement plans based on impact analysis of group and physician level reporting and audit outcomes; maintains an extensive understanding of regulatory compliance and provides leadership, support and participates in process and quality improvement initiatives.
Required Experience
  • 4+ years related work experience or equivalent combination of transferable experience and education. Experience Details: related experience, preferably in a Health Plan, managed care environment, or primary care physician's office
  • Bachelor’s degree or equivalent work experience
  • Required Licenses and Certifications, Certified Medical Record Coder
  • Knowledge of Medicare, ICD-10, CPT, HCPCS coding standards and guidelines, and Uniform Billing practices
  • Must have strong PC skills specifically utilizing the MS Office Suite products (e.g., MS Word, MS Excel, MS PowerPoint, etc.)
  • Excellent written and verbal communication and presentation skills
  • Has complete and thorough understanding of Risk Adjustment programs and can translate information at multiple audience levels.
  • Understanding of physician/facility practices and in supporting practice transformation through education for coding and documentation improvement.
  • Overnight travel required, up to 50%

 
Preferred Qualifications
  • In-depth knowledge of provider payment programs, contracting programs and payment methodologies.
  • Demonstrated knowledge of Medicare guidelines, rules and regulations
  • Thorough detailed understanding of the healthcare delivery system and understanding of Medicare Advantage Risk Adjustment and Risk contracting
  • MBA/MHA or equivalent • Prior experience with public speaking strongly preferred. Must be comfortable in settings ranging from one-on-one to large scale group meetings, and in environments that can be challenging.
  • Demonstrated BCBSF product knowledge of over and under 65 products as related to Risk Adjustment Programs
  • Demonstrated experience with alternative payment systems and Medicare Risk Adjustment structures
  • Demonstrated experience using project management skills to plan, organize, direct, supervise and accomplish goals; balance tasks
  • In depth knowledge of reform, and CMS compliance standards


 

My Profile

Create and manage profiles for future opportunities.

Go to Profile

My Submissions

Track your opportunities.

My Submissions

Internet Privacy Statement |  Terms of Use



We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. You may access the Nondiscrimination and Accessibility notice  here.


Language assistance available: Español, Kreyol Ayisien, Tiếng Việt, Português, 中文, français, Tagalog, русский, العربية, italiano, Deutsche , 한국어, Polskie, Gujarati, ไทย, 日本語, فارسی


Generally, the pronouns "our," "we" and "us" used throughout this website are intended to refer collectively to Blue Cross and Blue Shield of Florida, Inc. and its subsidiaries and affiliates. However, where appropriate, the content may identify a particular company; there, any pronouns refer to that specific entity.


Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. HMO coverage is offered by Health Options Inc., DBA Florida Blue HMO, an HMO affiliate of Blue Cross and Blue Shield of Florida, Inc. Dental, Life and Disability are offered by Florida Combined Life Insurance Company, Inc., DBA Florida Combined Life, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.


Florida Blue is an Equal Opportunity Employer - Minorities/Females/Protected Veterans/Disabled.


FB MFT 001 NF 092016© 2017 Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. All rights reserve.