Job Description

Position Summary

We are seeking a knowledgeable and proactive Risk Adjustment Educator to join our team. In this role, you will be responsible for educating and advising healthcare providers and practice staff on Medicare coding guidelines, with a focus on optimizing revenue through accurate risk adjustment coding. You will collaborate with internal departments, Optum/UnitedHealthcare Medicare Advantage (MA), and other health plans to develop and deliver impactful educational programs and reporting tools that support our practices and IPA revenue goals.

Key Responsibilities

Education & Communication

• Develop and present HCC education programs aligned with IPA ethical standards and Medicare guidelines.
• Collaborate with data analysts to create meaningful, practice-level reports that enhance coding accuracy.
• Partner with Medicare Advantage plans, Optum, and third-party vendors to support educational initiatives.

Problem Solving & Support

• Identify and address data flow issues within practices; develop action plans in collaboration with Practice Transformation Coaches.
• Resolve coding and submission barriers with external vendors (e.g., billing companies, clearinghouses).

Productivity & Documentation

• Conduct risk adjustment chart reviews.
• Educate providers and staff on documentation and coding techniques to accurately reflect patient acuity.

Customer Engagement

• Serve as a primary resource for coding and documentation inquiries.
• Build strong relationships with practices to foster engagement and understanding of risk adjustment’s impact on patient care and revenue.

Professional Development

• Stay current on CMS risk adjustment models, compliance standards, and industry changes.
• Maintain CPC certification and obtain CRC certification within one year of hire.

Qualifications

Education & Certification

• Bachelor’s degree in a health-related field (or 4 years of equivalent experience).
• Certified Professional Coder (CPC) – Required
• Certified Risk Adjustment Coder (CRC) – Required (or commitment to obtain within 1 year)

Experience

• 3–5 years of experience in medical records and/or coding, preferably in risk adjustment.
• Strong knowledge of Medicare rules, claims coding (CPT, HCPCS, ICD-10), and risk adjustment categories.

Skills & Competencies

• Proficient in MS Office, EMRs, coding software, and internet-based applications.
• Excellent communication, presentation, and relationship-building skills.
• Ability to analyze data, develop training programs, and respond to inquiries effectively.
• Strong organizational and time management skills with the ability to multitask and meet deadlines.

Additional Requirements

• Valid, unrestricted Colorado driver’s license.
• Reliable, insured vehicle.
• HIPAA-compliant home office setup for remote work.
• Mobile device for work use, per company policy.

Join us in making a meaningful impact on healthcare outcomes and provider success through education and collaboration. Apply today to be part of a mission-driven team!

Salary Range

$59,155.20 - $78,884.00

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