Clinical Risk Educator, Remote

Primary Duties

• The Clinical Risk Educator performs qualitative retrospective chart reviews for prioritized practices to ensure complete and accurate clinical documentation, utilizing quantitative measures to track the frequency and types of documentation errors and gaps. By analyzing review outcomes, they pinpoint specific areas for improvement in coding and clinical documentation while identifying trends and patterns that may indicate systemic issues or training needs. This role involves synthesizing concise, high-level summaries to illustrate findings, highlighting critical areas of concern, and prioritizing recommendations for improvement. Additionally, the Educator conducts educational sessions for Aledade ACO member practices and their key staff—delivered either in person or virtually—covering review findings, clinical documentation, and risk adjustment concepts.
• Serve as an individual contributor on the Risk Education team, collaborating with team members to develop and update educational materials related to clinical documentation for both internal and external audiences, inclusive of reference guides, slide decks, and toolkits. Conduct ongoing annual reviews of repository content to ensure alignment with CMS regulatory updates.
• Research, investigate and remain up to date on both clinical and coding guidelines as they relate to clinician documentation improvement.
• Serve as a resource for appropriate clinical documentation and coding practices for assigned region.

Minimum Qualifications

• Bachelor’s degree in a healthcare related field or equivalent work experience required
• 5+ years of clinical experience (in particular nursing or international medical backgrounds)
• Current medical coding certification such as Certified Professional Coder (CPC), Certified Coding Specialist - Physician-based (CCS-P), Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Expert Outpatient (CDEO), Certified Clinical Documentation Specialist-Outpatient (CCDS-O), etc. through AAPC, ACDIS, or AHIMA
• 2+ years of clinical documentation improvement experience
• Extensive knowledge of ICD-10-CM, HCPCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacology is required
• Subject matter expertise on the CMS HCC Risk Adjustment program, methodology, and impact to value-based contracts
• Comfortable presenting to large and small groups in person and in virtual format (Google Meet, Zoom, etc.)
• Ability to work both independently and collaboratively
• Flexible and able to multi-task and prioritize work load on a daily basis
• Availability for market-specific events, including the execution of 1-2 Saturday events per year in select markets
• Flexibility to work occasional evening hours, with the potential for 1-2 evenings per month on a national scale

Preferred KSA's

• Active nursing credential as Registered Nurse (RN), Licensed Practical Nurse (LPN), or international medical graduate (IMG)
• Background in working directly with providers in an outpatient setting
• Experience developing and delivering clinical education and training via Google Slides or Powerpoint presentations
• Ability to use insights from clinical and quality data to address opportunities for improvement
• Advanced knowledge of Medicare billing and coding regulations, along with a deep understanding of CMS compliance standards and guidelines
• General understanding of the billing requirements and reimbursement structures for FQHCs/RHCs
• Willingness to travel as needed to Aledade’s headquarters or markets

Physical Requirements

• Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
• Willingness to travel as needed to Aledade’s headquarters or markets (est. up to 25% across the year).