Provider Educator

Community Care Cooperative•Boston, MA

19d•$68,806 - $80,847•Remote

About The Position

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. The role partners 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 programs, including the Medicare Shared Savings Program (MSSP) ACO and the MassHealth ACO. The Provider Educator uses coding, claims, clinical, and performance data to identify educational opportunities, develop targeted interventions, and support providers in achieving documentation and coding excellence. The role is a subject matter expert in CMS-HCC risk adjustment methodologies for Medicare populations, including hands-on experience applying the CMS-HCC Version 28 (V28) model within a Medicare ACO setting, as well as proprietary and alternative risk adjustment models supporting Medicaid and value-based care programs, including the DxCG risk adjustment model used within C3’s MassHealth ACO contracts. Community Care Cooperative (C3) is a 501(c)(3) nonprofit multi-service organization governed by Federally Qualified Health Centers (FQHCs). Its mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people it serves. C3 operates as an FQHC-led accountable care organization and as a Management Services Organization for FQHCs, providing services that include value-based payor contract operations, compliance, financial and population health management, Epic EHR licensing and implementation, pharmacy operations, billing, credentialing, and employer-sponsored insurance. C3 describes itself as a fast-growing organization developing new partnerships and programs.

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 Version 28 (V28), and working knowledge of alternative methodologies, including the MassHealth DxCG 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 and 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.
Bachelor’s degree in Healthcare Administration, Public Health, Health Information Management, Nursing, Business Administration, or a related healthcare field.
AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS) certification.
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 Version 28 (V28), within a Medicare ACO (MSSP) or similar Medicare value-based care program.
Equivalent combinations of education and experience may be considered.
Employees are required to be vaccinated consistent with applicable law and infection control practices per Mass.gov recommendations.

Nice To Haves

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.
AAPC Certified Risk Adjustment Coder (CRC) certification.
Experience supporting Medicaid, ACO, or alternative risk adjustment models, including DxCG.

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; reviews are educational and do not establish diagnoses or direct coding.
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 affecting 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, and implications for Medicare ACO (MSSP) attributed populations.
Deliver annual ICD-10-CM code update education to coders and health center clinical teams, translating code changes into documentation guidance for risk adjustment.
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.