Job Description

Medicare Risk Adjustment- Provider Educator

Remote based w/ up to 25% in Florida.

Our mission is Better Health. Our passion is helping others.

What’s Your Why?

• Are you looking for a career opportunity that will help you grow personally and professionally?

• Do you have a passion for helping others achieve Better Health?

• Are you ready to join a growing team that shares your mission?

Why Join Our Team: At Better Health Group, it’s our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day! They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients . We don’t just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.

The Provider Educator Reports to : Manager of Provider Education

This Team Member will facilitate and provide detailed analysis, reporting, training, education, and support for providers and care teams across internal and external medical offices to promote accurate clinical documentation and risk adjustment opportunities identified during chart reviews or analytics.

Responsibilities & Expectations

The Provider Educator will directly support the Quality Operations Team as well as internal and external Providers. They will be expected to perform within the following scope, as well as other assigned duties and activities that aid and leverage our Team function. Responsibilities include and are not limited to:

• Responsible for successful education across internal and external Providers around condition identification, documentation and coding
• Ensure assigned Providers are trained and educated on CMS compliance and guidelines 
• Build, establish and maintain collaborative relationships with assigned Providers, office managers and internal Votion teams
• Remain up-to-date, educated and competent in applicable Health Plan, Medicare, AMA, ICD-10 and documentation changes
• Conduct chart audits to establish patterns of opportunity for improved documentation
  • Identify potential chronic conditions
  • Identify missing treatment plans
  • Ensure accurate identification and documentation of current active diagnosis only
• Educate providers in-person or remotely on the purpose of Risk Adjustment, Hierarchical Condition Categories (HCC), CMS Documentation Guidelines, Condition Identification, Appropriate Documentation with MEAT
• Flexible to accommodate Provider schedules when facilitating education and training needs
• Demonstrate attention to detail while reviewing 5 star forms completed by assigned Providers
  • Appropriate designation to medical conditions in patient’s medical history
  • Ensure the active conditions are billed with a proper ICD-10 code
  • Facilitate education and conversation of findings with Provider via video conference or in-person
• Provide onboarding and training for all new Primary Care Providers and Nurse Practitioners across internal and affiliate medical offices
  • Establish weekly meetings x1 month after onboarding to educate, guide and provide feedback to Providers regarding their conditional identification, documentation and coding
• Analyze key coding performance indicators to determine providers in need of initial or additional training, continually
  • Evaluate Providers on consistent identification of chronic conditions
• Responsible for developing HCC specific provider improvement plans based on analysis and internal review outcomes
• Develop and implement Quality Improvement Plans (QIP) as needed based on the chart reviews conducted to identify specific areas of training needs
• Assist Quality Analyst team in facilitating successful communication and education to the medical office champion when the Provider participates
• Update and maintain individual Provider profiles to identify strengths, areas of improvement and conditional identification, documentation and coding patterns
• Assist in creation and development of new playbooks, policies and procedures (p&p) or the revision of existing P&Ps around Provider education

• Expected to attend and participate in weekly team meetings with VP of Quality Operations
  • Create an agenda
• Expected travel as needed to any designated region to assist in leveraging Quality Operations initiatives
• Expected attendance, participation and facilitation (as needed) of “Bootcamp” and “Mini-Bootcamp” training forums (anticipated weeknight or weekend)
  • Assist in creating content
  • Facilitate and lead (as applicable) clinical conversations
  • Prepared to speak and present (as applicable)
• Other designated administrative, clinical support and tasks as assigned to leverage program goals

Key Attributes:

• Has a contagious and positive work ethic, inspires others, and model the behaviors of our core values and guiding principles
• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments.
• Is able to work within our Better Health environment by facing tasks and challenges with energy and passion.
• Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals.
• Demonstrated ability to handle data with confidentiality

Additional EDUCATION & SKILLS Preferred:

• Foreign Medical GraduateMD or RN License (Full or Limited License)
• CPC or CRC certification (Or ability to get certified within 6 months)
• 2 years of experience in a Risk Adjustment / Documentation preferred
• Proven ability to work with Google Suite software or equivalent (MS Excel and MS Powerpoint)
• Demonstrate high level communication skills and successful delivery of clinical information (ie: common chronic conditions)
• Ability to work independently with minimal supervision
• Excellent organizational, time-management, and multi-tasking skills with strong attention to detail
• Demonstrated resourcefulness, initiative, and results-oriented capabilities
• Ability to work in a shifting and fast-paced environment
• Ability and flexibility to work a traveling schedule as needed
• Must be able to work professionally with confidential information
• Excellent written and verbal communication skills.
• Ability to work cross-functionally with multiple teams
• Ability to shift focus, multi-task, and prioritize in a rapidly changing environment.
• STRONG reasoning and critical thinking required.
• MUST be results oriented with a focus on quality execution and delivery.

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