Clinical Risk Educator
2 days ago
Birmingham
Job DescriptionThe Clinical Risk Educator is responsible for developing and delivering educational content designed to improve accurate and complete clinical documentation practices. This role supports a diverse audience, including external clinicians, billers, coders, and Aledade’s clinical and non-clinical staff. Key responsibilities include interpreting and utilizing trended data related to CDI outcomes to identify learning opportunities primarily for clinical audiences. The Clinical Risk Educator collaborates with colleagues and leadership to design and implement educational materials, ensuring alignment with regulatory compliance requirements, and value-based care principles. This position requires a deep understanding of clinical documentation concepts and a commitment to fostering education that promotes high-quality, compliant documentation practices within a value-based care framework. Primary Duties: • Conduct educational sessions for Aledade ACO member practices and their key staff on clinical documentation and risk concepts, delivered either in person or virtually., • Serve as an individual contributor on the Risk Education team, collaborating with team members to develop and update educational materials related to clinical documentation, coding and billing for both internal and external audiences. Conduct ongoing annual reviews of repository content to ensure alignment with CMS regulatory updates., • Analyze clinical process measures and outcome data, informed by CDI chart reviews, market performance, and field team input, to identify knowledge gaps and opportunities. Address and clarify missing, unclear, conflicting, or non-compliant information captured by the CDIS, providing clear explanations and guidance to clinicians., • 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 Regional Market.Minimum Qualifications:, • Bachelor’s degree in a healthcare related field or equivalent work experience required, • 5+ years of clinical experience, • 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 scalePreferred Qualifications:, • 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 marketsPhysical Requirements: