Clinical Risk Educator

Job Description

Job Description

The 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 scale

Preferred 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 markets

Physical Requirements:

• Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.

Who We Are:

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

What Does This Mean for You?

At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.

In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:

Flexible work schedules and the ability to work remotely are available for many roles

Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners

Robust time-off plan (21 days of PTO in your first year)

Two paid volunteer days and 11 paid holidays

12 weeks paid parental leave for all new parents

Six weeks paid sabbatical after six years of service

Educational Assistant Program and Clinical Employee Reimbursement Program

401(k) with up to 4% match

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And much more!

At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.

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