Medicare Risk Adjustment Educator
About The Position
The Medicare Risk Adjustment (MRA) Educator plays a critical role in supporting Cano Health’s Medicare Advantage and ACO Reach programs. This role serves as a strategic partner to Cano Health providers, affiliated practices, clinical teams, and revenue cycle departments. The MRA Educator is responsible for driving accuracy in risk adjustment coding through education, guidance, and documentation review to ensure regulatory compliance and optimal patient care. The ideal candidate will possess deep knowledge of CMS-HCC risk adjustment models and ICD-10 coding principles. They will provide individualized feedback and training to providers and staff, monitor coding trends, and facilitate best practices that support accurate risk score capture and reimbursement.
Requirements
- Bachelor’s degree in healthcare, nursing, or related field required.
- CPC certification from AAPC or AHIMA equivalent required.
- Minimum 3 years in Clinical Documentation Improvement or related roles (e.g., risk adjustment coding, billing auditing).
- 5+ years in coding and billing (ICD-10, CPT, HCPCS).
- Strong analytical and data interpretation skills with experience using Excel and database tools.
- Expert knowledge of Medicare Risk Adjustment and HCC coding.
- Strong interpersonal and communication skills to educate providers individually and in group settings.
- Ability to identify potential fraud and abuse in documentation and coding.
- Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint).
- Highly organized with strong time management and problem-solving skills.
- Commitment to continuous improvement and professional development.
- Trustworthy, collaborative, and results-oriented mindset.
- Must be able to work extended and flexible hours and weekends as needed.
- Ensure all HIPAA compliance protocols are followed, including locking computers when unattended and securely handling printed medical documents.
Nice To Haves
- Additional AAPC certifications (CRC, CPMA, CDEO) preferred.
- Foreign medical degree (BN/RN) is a plus.
- Bilingual (English/Spanish) preferred.
Responsibilities
- Review clinical documentation for completeness, specificity, and alignment with Medicare Risk Adjustment (HCC) coding guidelines.
- Coordinate and conduct timely educational sessions with providers and staff, including scheduling, material preparation (minimum 48 hours in advance), follow-up documentation, and storage.
- Identify gaps in documentation and provide real-time guidance to improve accuracy and compliance.
- Clarify clinical conditions with providers to ensure accurate coding of chronic conditions and co-morbidities.
- Abstract clinical data and accurately assign appropriate ICD-10-CM codes.
- Conduct onboarding and retraining programs for providers, affiliates, and coding staff.
- Perform regular chart audits to monitor compliance and identify opportunities for improvement.
- Maintain expertise on CMS regulations, risk adjustment methodologies, and coding updates.
- Collaborate with quality assurance, coding, and operations teams to refine documentation workflows.
- Develop and implement training materials, tools, and best practices to improve risk adjustment documentation processes.
- Participate in continuing education to remain current with evolving coding standards and regulatory requirements.
- Support process improvements by analyzing data trends from audits and coding reviews.
- Address provider inquiries and concerns, serving as the key point of contact on risk adjustment matters.
Benefits
- No supervisory responsibilities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
