Provider Educator

Pay Range:

Please emailif you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI our greatest resource is our people.

We come from varying backgrounds different cultures and unique experiences. We are hard-working caring and creative individuals who collaborate support one another and grow together. Passion empathy and understanding are at the forefront of everything we donot just for our members but for our employees as well.

We recognize that to do your best work you have to be your best self.
Its why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health dental and vision insurance as well as programs that support your mental health and well-being. We pay competitively offer bonuses and investment plans and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where youre at in the organization youre an integral part of our team and your input thoughts and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

Were dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality affordable and equitable care. To further improve the health and well-being of our fellow Rhode Islanders we regularly roll up our sleeves and get to work (literally) in communities all across the statebuilding homes working in food pantries revitalizing community centers and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can our associates receive additional paid time to volunteer.

Why this job matters:

Perform daily operations of provider education as it pertains to Risk Revenue and Quality department. Execute the development implementation and maintenance of departmental policies procedures and programs.

What you will do:

• Coordinate with ACOs on common strategies to improve quality coding and health equity.

• Work with the analytics team to set metrics to measure the success of the program and monitor progress of individual providers.

• Works with the analytics team and ACO leadership to identify providers who would benefit from a provider education program and prioritize engagement.

• Takes feedback from ACO and internal leadership to focus on areas of educational need and improve process

• Stays up-to-date on the latest ICD-10 guidelines OIG Letters CMS guidance and Coding Clinics and is able to relay that information internally and externally.

• Creates training material to distribute externally to ACOs.

• Works with the coding education manager to improve accuracy and ensure material has relevance to organizational goals.

• Provide virtual and/or onsite presentations on chart reviews and various topics related to quality improvement to clinicians staff and leadership.

• Works with the internal and external teams to develop individualized presentations and plans for providers.

• Ability to analyze risks in documentation billing and quality and implement a plan to mitigate those risks through intervention.

• Utilize analytical thinking to assess coding data and trends.

• Review basic analytic reports to evaluate coding accuracy and efficiency.

• Present analytic findings and insights during provider training sessions to inform and improve coding practices

• Works with the coding education manager to maintain a schedule of provider education visits to maintain a routine in order to provide timely feedback to clinicians.

• Execute the development implementation and maintenance of departmental policies procedures and programs.

• Perform other duties as assigned.

What you need to succeed:

• CPC and CRC coding certification from AAPC CCS coding certification from AHIMA

• Three to five years of experience in provider education HCC coding and care management years provider education experience 3 years of experience in healthcare.

• Proven analytic experience using Microsoft Excel database query capabilities and ability to evaluate data at various levels of detail

• Strong and effective decision-making skills

• Excellent organizational skills and ability to successfully prioritize multiple tasks Proficiency with Microsoft Suite of products (i.e. Word Excel PPT etc.)

• Ability to effectively interact with all levels of the organization

• Excellent verbal and written communication skills with ability to convey complex or technical information in an effective manner

• Proficiency in ICD/10-CM medical coding Advanced analytical skills with the ability to interpret and synthesize basic data sets

• Knowledge of business process improvement techniques and strategies

• Negotiation skills

• Presentation skills

• Ability to effectively navigate ambiguous situations with limited direction

The extras:

• Bachelors degree or an equivalent combination of education and experience

Location:
BCBSRI is headquartered in downtown Providence conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states pending approval from the Human Resources Department: Arizona Connecticut Florida Georgia Louisiana Massachusetts North Carolina Oklahoma Rhode Island South Carolina Texas Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do and it strengthens our ability to meet the challenges of todays healthcare industry. BCBSRI is an equal opportunity employer.

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