Risk Adjustment Specialist – Non-Clinical

This is a fully remote position, open to applicants in Texas, +1 more state.

📋 Description

• Engage and educate healthcare providers on the precise capture and reporting of chronic conditions for effective revenue management.

• Ensure that programs adhere to state and federal regulations.

• Engage, train, and provide monthly updates for a cohort of 60–100 providers.

• Leverage data to create strategies and best practices that assist providers in earning incentives and enhancing company revenue.

• Ensure the receipt of medical records and collaborate with vendors to address any obstacles.

• Guarantee that providers comply with mandated audits and requests for medical records.

• Conduct outreach via phone, email, and Zoom meetings.

• Act as the primary point of contact for provider inquiries, reports, and issues throughout the duration of projects.

• Utilize Excel and internal tools to generate engagement, issue, and progress reports.

• Review and analyze project data to pinpoint barriers and formulate strategies for provider success.

• Utilize vendor portals to identify challenges in obtaining medical records for risk adjustment.

• Research provider information using internal systems and online resources.

• Reach out to provider offices and share best practices for acquiring medical records for coding and abstraction.

⛳️ Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship, now or in the future.

• High School Diploma or GED is required.

• A minimum of 2 years' experience in Health Insurance, Customer Service, Claims, or Provider Office roles is required.

• Experience in Health Insurance is preferred.

• Willingness to travel in-state up to 10% of the time is necessary.

• Proven experience in provider engagement, training, data analysis, and reporting.

• Proficiency in Excel and internal tools is essential.

• Capability to utilize vendor portals, internal systems, and conduct internet research.

• Strong professional oral and written communication skills are required.

• Ability to conduct outreach through phone, email, and Zoom meetings is necessary.

🏝️ Benefits

• Competitive salary.

• Comprehensive health insurance.

• 401K retirement plans.

• Stock purchase plans.

• Tuition reimbursement options.

• Paid time off and holidays.

• Flexible arrangements for remote, hybrid, field, or office work schedules.

• Additional incentive options may be included in overall compensation.

• Equal opportunity employer committed to fostering diversity.