Provider Educator

Location:

Remote Organization

Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.

As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to be the market leader in the Mass Health ACO Program. We are the largest Medicaid ACO in Massachusetts, and we operate a variety of business offerings nationwide.

As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others. We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

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.

This role partners closely 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 (ACO) programs, including the Medicare Shared Savings Program (MSSP) ACO and the Mass Health ACO.The Provider Educator utilizes coding, claims, clinical, and performance data to identify educational opportunities, develop targeted interventions, and support providers in achieving documentation and coding excellence.

The role serves as a subject matter expert in CMS-HCC risk adjustment methodologies utilized 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 utilized within C3’s Mass Health ACO contracts.

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 in documentation quality, coding accuracy, and risk adjustment performance; reviews are educational in nature 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…