Medicare Risk Adjustment Provider Educator Jobs

Provider Educator - Job Description
Employment Type: Full-Time, Exempt
Location: Remote, with travel into MN as needed
Reports To: Quality Manager, STARS

Who We Are:
At Herself Health, we're on a mission to help women get more life out of life, together.

We're reimagining primary care for women on Medicare by delivering the kind of care they deserve: thoughtful, relationship-centered, and designed specifically for the realities of aging. We believe healthcare should never feel rushed, impersonal, or one-size-fits-all. That's why our care model gives patients more time with their care team and focuses on the health issues that matter most to women later in life—from post-menopausal care and bone health to weight management, preventive care, and mental, emotional, and social well-being.

We're building more than a better healthcare experience—we're building a team united by purpose. Every role at Herself Health contributes to creating exceptional experiences for our patients, our teammates, and the communities we serve.

Our values guide how we work every day:

• Her, First – We put women at the center of every decision and every interaction.
• Curious, Always Learning – We ask questions, embrace new ideas, and continuously improve.
• Own It, Act – We take initiative, follow through, and hold ourselves accountable for results.
• Together, Unstoppable – We achieve more through collaboration, trust, and supporting one another.

Today, Herself Health serves women 65+ in five primary care clinics dispersed across the Twin Cities metro of Minnesota. As we continue to grow, we're looking for passionate, mission-driven people who want to help shape the future of healthcare for women.

About the Provider Educator Role:

The Provider Educator provides analysis, reporting, education, training, and ongoing support to treating clinicians and care teams to promote accurate and complete documentation of patient conditions.

The role conducts pre-visit chart reviews to organize relevant clinical information and identify potential documentation, coding, and risk-adjustment opportunities for the treating clinician's review and clinical consideration. The Provider Educator also performs post-visit chart validations and audits, initiates appropriate clarification queries, and provides targeted feedback and education based on identified documentation trends.

Essential Functions

Provider Education and Support

Develop and deliver education to treating clinicians and care teams on:

• Accurate and complete clinical documentation, including MEAT (Monitor, Evaluate, Assess/Address, and Treat)
• Identification and documentation of HCC and non-HCC conditions
• ICD-10-CM coding principles, including clinical specificity, laterality, condition relationships, and complications
• CMS risk-adjustment requirements and organizational documentation standards
• Develop and update presentations, quick-reference sheets, case studies, and other educational resources, ensuring content is clinically accurate, current, appropriately sourced, and aligned with applicable guidance.
• Serve as a resource for documentation and coding questions and initiate appropriate clarification queries based on post-visit review findings.
• Facilitate remote and in-person education, as needed, and present clinical conditions, documentation, and coding concepts in a practical, clinician-friendly manner.
• Assist with developing and revising provider education materials and workflows.

Chart Preparation and Documentation Review

• Review available medical records before scheduled visits and organize relevant clinical information, including laboratory results, imaging, specialist documentation, hospital records, medications, diagnoses, and medical history.
• Identify potential documentation, coding, and risk-adjustment opportunities, gaps, inconsistencies, and changes in condition status for the treating clinician's review and clinical consideration.
• Conduct post-visit chart reviews and validations to identify documentation gaps, inconsistencies, and clarification opportunities related to diagnosis support, clinical specificity, condition status and relationships, treatment plans, and coding accuracy.
• Conduct monthly CDI audits and other reviews, as needed, to identify documentation trends and evaluate the effectiveness of education.

Documentation Performance and Clinician Development

• Analyze documentation, coding, query, and risk-adjustment performance indicators to identify treating clinicians who may benefit from additional education.
• Develop individualized education and documentation-improvement plans based on chart-review findings, performance trends, and organizational priorities.
• Maintain clinician education profiles documenting completed education, strengths, recurring patterns, improvement opportunities, and follow-up needs.
• Monitor education effectiveness, provide ongoing feedback, and escalate recurring documentation, coding, compliance, or workflow concerns as appropriate.
• Support the onboarding of newly hired treating clinicians through education on documentation standards, ICD-10-CM principles, CDI processes, risk adjustment, and clarification queries.
• Conduct post-onboarding follow-up to review documentation performance, provide feedback, and reinforce expectations.

Collaboration and Additional Responsibilities

• Establish and maintain collaborative relationships with treating clinicians, care teams, clinic leadership, coding & billing team and other operational teams.
• Collaborate with coding teams to address documentation and coding concerns and promote consistent education across all conditions.
• Participate in team, coding, interdisciplinary, and other assigned meetings.
• Travel to assigned clinic locations or organizational events as needed.
• Perform other related duties that support departmental and organizational goals.

Documentation and Compliance Standards

• Ensure education, feedback, and clarification requests are accurate, objective, non-leading, and supported by the available medical record and applicable guidance.
• Maintain the treating clinician's authority and responsibility for clinical assessment, diagnosis selection, and treatment decisions.
• Protect confidential patient, clinician, payer, and organizational information and comply with HIPAA, privacy requirements, and organizational policies.
• Escalate identified documentation, coding, privacy, or compliance concerns through appropriate organizational channels.

Must-have Qualifications and Skills:

• Foreign Medical Graduate, or active RN license, as permitted by organizational and state requirements.
• Certified Risk Adjustment Coder certification or ability to obtain CRC certification within six months of hire.
• Ability to review medical records, analyze documentation patterns, and provide clear, constructive, and clinically relevant feedback.
• Strong written, verbal, presentation, facilitation, organizational, and interpersonal skills.
• Ability to work independently, manage competing priorities, and collaborate effectively across multiple teams.
• Ability to adapt to changing priorities and processes in a fast-paced environment.
• Ability to travel as needed.

Nice-to-have Qualifications and Skills:

• Minimum of two years of experience in risk adjustment, clinical documentation integrity, provider education, medical coding, clinical practice, nursing, or a related healthcare field.
• Certified Professional Coder certification.
• Working knowledge of acute and chronic conditions, clinical terminology, documentation principles, ICD-10-CM coding, and risk-adjustment models, including CMS-HCC V28.
• Experience providing documentation and coding education to treating clinicians.
• Experience with Medicare Advantage, value-based care, clinical documentation integrity, risk adjustment, or clinician-performance programs.
• Knowledge of documentation and coding requirements for HCC and non-HCC conditions.
• Proficiency with Microsoft Office or equivalent spreadsheet and presentation software.
• Strong clinical reasoning, critical thinking, analytical, and problem-solving skills.
• Experience using athenahealth preferred.

We support Equal Employment Opportunities (EEO). We are committed to an inclusive workplace. We do not discriminate based on race, religion, color, national origin, gender identity or expression, age, marital status, veteran status, disability status, parental status, political affiliation, or any other status protected by federal, state, or local laws.
All employees of Herself Health are expected to fully understand and abide by the practice's compliance policies and procedures. Employees are provided training upon hire and annually and regularly notified of changes as needed. It is expected that all employees will report any suspected violations of any federal or state laws to their direct supervisor, Human Resources, or the Compliance Officer.