Risk Adjustment Provider Engagement Specialis

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

The Provider Engagement Specialist plays a critical role in developing short and long-term plans and contributing to strategic and operational projects within Risk Adjustment. This position collaborates closely within the Risk Adjustment department and with network and value-based care teams in developing targeted strategies and providing strategic guidance for increasing provider engagement and performance enhancement initiatives. This role will be responsible for monitoring and measuring physician behavior and performance to assist providers in adapting to ongoing Risk Adjustment requirements and activities, and inform internal decision making and strategy development. The ideal candidate will be a resource to Horizon’s provider facing teams for the purposes of improving medical record documentation and coding performance, providing a second level of expert consultation, and will be required to coordinate with internal provider relationship owners on the development/maintenance of key initiatives. As an RA Provider Engagement Specialist you will leverage analytics and other reporting to generate insights within Horizon’s Risk Adjustment Management team to deliver a robust engagement strategy for Horizon’s provider partners.

• Accountable for the ongoing development of network engagement strategies related to improving coding and documentation standards for providers, supporting and educating Horizon’s internal network teams on risk adjustment.
• Support the development and implementation of network engagement strategies focused on improving Risk Adjustment coding and documentation.
• Analyzes provider-related coding practices and data in order to recommend actions and solutions that strengthen the provider's understanding of proper coding and documentation practices.
• Develop material and perform education for internal Horizon provider facing staff on key Risk Adjustment initiatives and strategies.
• Monitor and report to leadership regarding identified trends, concerns and/or opportunities found through review of medical charts and claims or other performance measures.
• Collaborates in the development of educational materials and facilitate sessions customized to targeted or generic audiences of providers, office managers, and their staffs for the purposes of risk adjustment.
• Develop and maintain relationships with key stakeholders within Horizon and the provider community gathering feedback and strategic perspectives
• Initiates communication with other members of the Physician Relations team and representatives from appropriate areas to effectively troubleshoot complex Risk Adjustment inquiries in order to improve coding accuracy and documentation quality.

Education/Experience

• Bachelor’s degree preferred from an accredited college or university, in Business, Marketing, Communications, Healthcare Administration or equivalent work experience.
• Requires a minimum of 5 years healthcare experience with provider or client focus/interaction, and at least 1 year of experience in a Lead Associate role: leading projects, interacting with clients, or healthcare providers.

Knowledge

• Provider or other healthcare consulting experience a plus.
• Prior Risk Adjustment experience a plus.
• Experience working with clinicians and billing/coding staff a plus.
• Demonstrated experience organizing meetings for small to medium audiences including developing materials, event planning, and execution.
• Understanding of the healthcare industry including payors and providers.
• Knowledge of New Jersey physician community preferred.
• Knowledge of coding guidelines and documentation standards, CPC/CRC certification a plus.
• Experience facilitating and/or participating in small to large scale meetings to different audiences including clinicians and/or senior level executives
• Must be fully proficient in MS Office (Word, PowerPoint, Excel, etc.)

Skills and Abilities

• Strong Verbal and Written Communication Skills
• Organized
• Strategic/ Critical Thinking
• Sound Judgment & Decision Making
• Proven Analytical and Problem Solving abilities
• Strong Presentation and Public Speaking Skills
• Project Management Skills
• Proven ability to synthesize and summarize data for different audiences.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

$86,000 - $117,390

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.