Provider Engagement Specialist I/II

The Provider Engagement Specialist promotes, contributes, and grows provider relationships through education, engagement, and outreach activities. The role enhances relationships with providers to support member health and is responsible for the overall performance of assigned practices within risk adjustment programs.

This role is located in Northern Idaho and services provider offices in that region.

Travel is typically 2–3 days a week, twice a month to clinic offices in Northern Idaho, with travel to Blue Cross of Idaho's main campus in Meridian, Idaho once per quarter.

Your day may look like

• Develop content and conduct training to assigned practices.
• Influence, develop, and maintain provider education materials related to risk adjustment.
• Manage and coordinate the creation, distribution, and collection of clinical documentation and coding improvement tools.
• Analyze and interpret provider risk adjustment performance reports and develop plans to meet target performance metrics.
• Interpret and maintain current risk adjustment regulatory rules and guidelines to ensure compliance with internal policies, procedures, and workflows.
• Analyze reporting or provider education programs to identify opportunities for education and enhanced reporting.
• Identify and lead performance improvement projects that maximize provider value-based reimbursements.
• Perform risk adjustment medical record reviews as a primary coder and communicate findings to providers.