Medicare Risk Adjustment Educator

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

• 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.

• 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.

• No supervisory responsibilities.

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…