Medicare Risk Adjustment Educator

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Job Summary

The Medicare Risk Adjustment (MRA) Educator plays a critical role in supporting Cano Healths 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.

Essential Duties & 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.

Additional Duties & Responsibilities

• 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.

Supervisory Responsibilities

• No supervisory responsibilities.

Best Practices

Maintain exceptional attention to detail and accuracy in clinical documentation review.

Demonstrate strong knowledge of Medicare Risk Adjustment (HCC) models and their influence on healthcare reimbursement.

Work independently with the ability to prioritize tasks manage multiple projects and meet deadlines consistently.

Exhibit excellent interpersonal and communication skills when engaging with medical professionals coders and cross-functional stakeholders.

Possess deep understanding of healthcare regulations including risk adjustment coding CMS-HCC Hierarchy Model and other relevant industry standards.

Identify and address potential areas of fraud waste and abuse in documentation and coding in accordance with regulatory agency guidelines.

Conduct comprehensive chart reviews to support accurate and compliant documentation practices.

Design and deliver provider education programs effectively engaging both individuals and groups.

Apply critical thinking and problem-solving skills to assess interpret and resolve documentation and coding issues.

Demonstrate strong proficiency in data analysis and reporting to inform recommendations and decision-making.

Consistently meet performance targets while upholding high standards of accuracy and efficiency.

Leverage Microsoft Office tools (Excel PowerPoint Word Outlook) and internal reporting platforms effectively.

Quickly adapt to proprietary systems and tools to manage productivity and performance metrics.

Maintain a commitment to continuous learning and staying informed on industry developments coding updates and compliance changes.

Demonstrate flexibility and availability for frequent travel to clinical locations with reliable transportation for in-person engagements.

Ensure all HIPAA compliance protocols are followed including locking computers when unattended and securely handling printed medical documents.

Education & Experience

• Bachelors degree in healthcare nursing or related field required.
• CPC certification from AAPC or AHIMA equivalent required.
• Additional AAPC certifications (CRC CPMA CDEO) preferred.
• Foreign medical degree (BN/RN) is a plus.
• 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.

Education Requirements

Required/Preferred

Education Level

Discipline

Required

Bachelors Degree

Healthcare nursing or a related field.

Knowledge Skills & Proficiencies

• 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).
• Bilingual (English/Spanish) preferred.
• Highly organized with strong time management and problem-solving skills.
• Commitment to continuous improvement and professional development.
• Trustworthy collaborative and results-oriented mindset.

Physical Requirements

This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods. Must be able to stand sit walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include the ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing standing sitting stooping and occasionally climbing

Travel Requirements

Flexible work location: This is a HYBRID role.

Amount of Expected Travel

Details

Required

0-90%

may be required to provider offices medical centers or affiliate locations.

Tools & Equipment Used

Computer and peripherals standard and customized software applications and tools and usual office equipment.

Disclaimer

The above information in this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties responsibilities and qualifications required of employees assigned to this job. This is not an all-inclusive job description; therefore management has the right to assign or reassign schedules duties and responsibilities to this job at any time.

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