Provider Engagement Specialist (CPC or CRC Required) – Remote

Job Description

Veradigm Payer 

Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.

Solutions from Veradigm Payers:

• Deliver insights to drive quality outcomes cost-effectively
• Improve efficiency for themselves, their providers, and their members through high-speed clinical data exchange
• Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider’s existing workflow

Position Description 
Provider Engagement Specialist will have the unique opportunity to interact with multiple areas of the business.  The ideal candidate will manage, coordinate and collaborate with providers and customers daily to increase the understanding of Risk Adjustment, Quality and Value Based Care Payment Models while utilizing our business intelligence tools. Train staff and providers on the utilization of Veradigm Solutions to ensure that our customers’ successfully implement and utilize our solutions and that success is reflected in improved provider engagement and associated performance when relating to Risk Adjustment, Quality and other Care Gap Closure activities.

What you will contribute:

• Support the Customer Support and Provider Engagement Team project management while delivering customer and provider support to promote efficient gap closure activities
• Develop, implement and conduct effective training sessions regarding risk adjustment documentation and coding and quality. Act as a subject matter expert, sharing best practices with providers and their support personnel as well as the customer to support and encourage chronic condition and quality gap closure.
• Serve as a customer advocate for all open issues and drive timely issue resolution for all Provider facing tools and solutions
• Ensure internal support teams are fully aware of customer issues and or provider concerns and have a complete understanding of the concern
• Support Risk Adjustment and Quality gap closure activities through developing provider, practice and customer relationships
• Collaborate with internal support teams to troubleshoot issues and support creative solutions
• SME in provider engagement activities including utilizing Veradigm solutions to target, engage and support customer utilization of Veradigm Payer Solutions
• Primarily support the Provider Engagement and Customer Engagement teams with engagement activities including contacting providers via email and phone for outreach, marketing, and engagement campaigns
• Provides comprehensive reporting on Provider Engagement activities for each of our customers
• Conducts consistent analysis on all Provider Engagement activities via reporting to internal stakeholders
• Conduct and manage email to increase awareness and utilization of webinars and provider tools
• Manage database of Provider Engagement contacts, targets, and communications
• Follow-up with providers and support personnel on educational opportunities based on feedback of chronic conditions and quality measures on provider alerts

The ideal candidate will have:

• CPC (Certified Professional Coder)  or CRC (Certified Risk Adjustment Coder) required
• Ambulatory care experience
• Knowledge of the Medicare, Commercial and Medicaid Risk Adjustment programs, Quality, HEDIS and 5 STAR Programs, Member Engagement and Value Based Care
• Experience with RADV in both the Medicare and Commercial markets
• Motivated, professional, enthusiastic and efficient collaborator who is an effective communicator
• Comfortable with leading meetings, training and demonstrating healthcare solutions
• Familiarity with best practice ambulatory care workflows and development
• Customer service experience and highly effective in relationship building
• Health Plan experience with Quality, Stars and Case management programs
• Comfortable and confidently speaking with providers and a strong ability to conduct effective training sessions
• Understanding of claims data and submission of ICD-10-CM HCC codes
• Superior project management, organization and communication skills are required
• The ability to communicate complex concepts across all levels of an organization as necessary
• The successful candidate will have an aptitude for and an interest in analytical processes and problem solving
• Proficient use of Microsoft Excel, Word, Power Point
• Demonstrates attention to detail