[Hiring] Provider Educator @Community Care Cooperative

Role Description

The Provider Educator – Risk Adjustment & Value-Based Care serves as a subject matter expert responsible for developing, implementing, and delivering provider education programs focused on clinical documentation, risk adjustment coding, population health, and value-based care performance.

• Partners closely with participating health centers, providers, medical leadership, and operational teams to improve documentation quality, coding accuracy, risk capture, quality outcomes, and overall performance across C3’s Medicare, Medicaid, and Accountable Care Organization (ACO) programs.
• Utilizes coding, claims, clinical, and performance data to identify educational opportunities, develop targeted interventions, and support providers in achieving documentation and coding excellence.
• Serves as a subject matter expert in CMS-HCC risk adjustment methodologies utilized for Medicare populations.

Responsibilities

• Design, develop, and deliver provider education programs focused on risk adjustment documentation, coding accuracy, clinical documentation integrity, and value-based care performance.
• Create educational materials, provider training curricula, presentations, job aids, coding reference tools, and provider-facing resources.
• Conduct educational provider documentation and coding reviews to identify opportunities for improvement in documentation quality, coding accuracy, and risk adjustment performance.
• Analyze coding, claims, RAF, quality, utilization, and population health data to identify provider performance trends and educational opportunities.
• Partner with participating health centers to improve documentation practices, coding outcomes, and performance under value-based reimbursement arrangements.
• Provide individualized coaching, mentorship, and education to providers identified as underperforming in risk adjustment, recapture rates, documentation quality, coding accuracy, or value-based care metrics.
• Collaborate with the Senior Director of Risk Adjustment, Senior Medical Director, clinical leadership, and operational teams to develop and execute provider engagement and education strategies.
• Educate providers on CMS-HCC, DxCG, and other applicable risk adjustment methodologies impacting Medicare, Medicaid, MSSP, ACO, and other value-based care contracts.
• Educate providers and health center teams on the CMS-HCC Version 28 model, including changes in condition category mapping, specificity and documentation requirements.
• Deliver annual ICD-10-CM code update education to coders and health center clinical teams.
• Support implementation of documentation and coding improvement initiatives across participating health centers.
• Monitor provider education effectiveness and recommend ongoing process improvements to maximize performance outcomes.
• Serve as a coding and documentation resource for providers, health center leadership, and internal stakeholders.
• Maintain current knowledge of CMS regulations, ICD-10-CM coding guidelines, risk adjustment methodologies, clinical documentation standards, and value-based care industry best practices.
• Support organizational initiatives related to Medicare Advantage, MassHealth ACO, MSSP, Medicaid, and other value-based reimbursement programs.

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Health Information Management, Nursing, Business Administration, or a related healthcare field required.
• AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS) required; AAPC Certified Risk Adjustment Coder (CRC) preferred.
• Minimum of 3-5 years of progressive experience in risk adjustment, medical coding, clinical documentation improvement, provider education, population health, value-based care, or healthcare consulting.
• Demonstrated experience educating physicians, advanced practice providers, and clinical teams on documentation and coding best practices.
• 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 required.
• Experience supporting Medicaid, ACO, or alternative risk adjustment models, including DxCG, strongly preferred.
• Equivalent combinations of education and experience may be considered.

Requirements

• Advanced knowledge of ICD-10-CM coding principles, clinical documentation integrity, and risk adjustment methodologies.
• Strong understanding of CMS-HCC risk adjustment models, including demonstrated experience with the Version 28 (V28) model.
• Demonstrated experience supporting risk adjustment and provider education within a Medicare ACO (MSSP or ACO REACH) or similar Medicare value-based care program.
• Knowledge of Medicare, Medicaid, MSSP, ACO, and value-based reimbursement models.
• Experience conducting provider education, training, coaching, and performance improvement initiatives.
• Strong analytical skills with the ability to interpret coding, claims, quality, utilization, and performance data.
• Ability to identify trends, performance gaps, and educational opportunities through data analysis.
• Excellent verbal, written, presentation, and facilitation skills.
• Strong relationship-building skills with providers, health center leadership, and multidisciplinary teams.
• Proficiency with electronic health records, coding software, reporting platforms, and population health tools.

Desired Other Skills

• Experience working within Federally Qualified Health Centers (FQHCs), Accountable Care Organizations (ACOs), Independent Practice Associations (IPAs), or other value-based healthcare organizations.
• Experience supporting Medicare Advantage, Medicaid ACO, MSSP, ACO REACH, or similar risk-bearing contracts.
• Experience with Epic, including Epic risk adjustment and condition review tools, within FQHC or community health settings.
• Experience using risk adjustment analytics and recapture reporting (such as Milliman or Arcadia) to target provider education.
• Experience developing provider-facing educational programs and training materials.
• Knowledge of population health management, quality improvement methodologies, and healthcare analytics.
• Experience with anti-racism activities and/or lived experience with racism is highly preferred.

Benefits

• In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law.