Provider Educator

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Design, develop, and implement educational programs for providers focusing on risk adjustment documentation, coding precision, clinical documentation integrity, and performance in value-based care.

• Produce educational resources, training curricula for providers, presentations, job aids, coding reference materials, and resources for provider engagement.

• Perform reviews of provider documentation and coding to pinpoint areas for improvement.

• Analyze data related to coding, claims, RAF, quality, utilization, and population health to uncover performance trends and educational opportunities.

• Collaborate with participating health centers to enhance documentation practices, coding results, and performance in value-based reimbursement.

• Offer personalized coaching, mentorship, and training to providers who are underperforming.

• Work together with the Senior Director of Risk Adjustment, Senior Medical Director, clinical leadership, and operational teams.

• Instruct providers on CMS-HCC, DxCG, and various risk adjustment methodologies applicable to Medicare, Medicaid, MSSP, ACO, and value-based care contracts.

• Teach providers and health center teams about the documentation requirements of the CMS-HCC Version 28 model.

• Provide annual education on updates to ICD-10-CM codes.

• Assist in initiatives aimed at improving documentation and coding across participating health centers.

• Evaluate the effectiveness of provider education and propose process enhancements.

• Act as a coding and documentation resource for providers, health center leadership, and internal stakeholders.

• Stay informed about CMS regulations, ICD-10-CM coding standards, risk adjustment methodologies, clinical documentation guidelines, and best practices in value-based care.

• Support related initiatives for Medicare Advantage, MassHealth ACO, MSSP, Medicaid, and other value-based reimbursement programs.

⛳️ Requirements

• A Bachelor's degree in Healthcare Administration, Public Health, Health Information Management, Nursing, Business Administration, or a related healthcare discipline is required.

• AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS) certification is required.

• AAPC Certified Risk Adjustment Coder (CRC) certification is preferred.

• At least 3–5 years of progressive experience in risk adjustment, medical coding, clinical documentation improvement, provider education, population health, value-based care, or healthcare consulting is required.

• Proven experience in educating physicians, advanced practice providers, and clinical teams on best practices for documentation and coding.

• Demonstrated experience with CMS-HCC risk adjustment methodologies, including the Version 28 (V28) model, within a Medicare ACO (MSSP) or similar Medicare value-based care program is required.

• Experience in supporting Medicaid, ACO, or alternative risk adjustment models, including DxCG, is strongly preferred.

• Advanced understanding of ICD-10-CM coding principles, clinical documentation integrity, and risk adjustment methodologies is essential.

• Strong grasp of CMS-HCC V28 and alternative risk adjustment methodologies, including the MassHealth DxCG model.

• Knowledge of Medicare, Medicaid, MSSP, ACO, and value-based reimbursement models.

• Experience in conducting provider education, training, coaching, and performance improvement initiatives.

• Ability to analyze and interpret coding, claims, quality, utilization, and performance data.

• Capacity to identify trends, performance gaps, and educational needs through data analysis.

• Excellent verbal, written, presentation, and facilitation abilities.

• Strong skills in building relationships with providers, health center leadership, and multidisciplinary teams.

• Proficiency in the use of electronic health records, coding software, reporting platforms, and population health tools.

• Combinations of education and experience that are equivalent may be considered.

• Employees must be vaccinated in accordance with applicable law.

🏝️ Benefits

• Salary range of $68,806–$80,847 annually.

• Vaccination consistent with applicable law is required for infection control compliance.