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Clinical Documentation Educator
Wellvana. Partner with affiliated practices and health systems on risk adjustment coding, regulatory requirements, and documentation procedures for attributed patients in Medicare Advantage, MSSP, and ACO LEAD programs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in risk adjustment coding, regulatory compliance, and documentation improvement, with a strong focus on provider education and data analysis. Proven ability to communicate effectively with healthcare providers and implement best practices to enhance coding accuracy and quality.
Highest-signal resume keywords
Risk Adjustment CodingCMS-HCC Risk Adjustment ModelCRC CertificationData AnalysisProvider Education Programs
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Risk Adjustment CodingDocumentation ImprovementChart ReviewData AnalysisCoding ComplianceQuality ProvisionsFraud DetectionReporting ProficiencyMicrosoft ExcelMicrosoft PowerPoint
Soft Skills
Effective CommunicationInterpersonal SkillsProblem-SolvingAttention to DetailCommitment to Continuous Learning
Tools & Technologies
ArcadiaSalesforceMicrosoft OfficeAI-Enabled ToolsProprietary Toolsets
Certifications & Qualifications
CRC CertificationCPC CertificationCPMA Certification
Industry Keywords
Healthcare RegulationsValue-Based CarePopulation HealthRisk AdjustmentCMS Compliance
About the role
Key responsibilities & impact- Partner with affiliated practices and health systems on risk adjustment coding, regulatory requirements, and documentation procedures for attributed patients in Medicare Advantage, MSSP, and ACO LEAD programs
- Review clinical data and patient documentation to validate and support accurate diagnosis capture before in-office physician visits
- Deliver personalized feedback to providers and practices
- Identify coding trends and documentation patterns through audits and data analysis
- Drive continuous improvement in documentation quality
- Communicate and implement coding education initiatives and ensure provider understanding and compliance
- Support change management and adoption of documentation and coding best practices
- Coordinate and schedule practice visits
- Prepare and distribute practice-specific materials at least 48 business hours before sessions
- Conduct education sessions, document follow-ups, and store materials in a central repository
- Analyze coding-review data and internal-audit results to identify provider documentation and coding error trends
- Construct training materials using internal standards and practice data
- Consult with providers and billing staff to correct errors
- Escalate unresponsive partners or non-adherence to leadership
- Maintain practice schedules, visit and travel logs, and education materials
- Distribute educational materials and coding tools
- Complete special projects assigned by leadership
- Build and maintain relationships with assigned physicians and practice staff
- Perform monthly in-person or virtual visits to assigned offices
- Review patient medical records before upcoming patient visits
- Monitor prospective and concurrent workflow adoption and correct issues
- Ensure timely submission of coding corrections
- Collaborate with Provider Account Management, risk adjustment, and audit teams
- Follow up on action items and coordinate completion with practices and internal teams
- Meet practice-visit, meeting-cadence, materials-distribution, and materials-storage performance targets
- Distribute retrospective claim edits and support partners through the submission process
- Perform post-reviews of action items to assure compliance
- Track improvements in provider coding quality scores
- Submit required reports and productivity metrics on time
- Maintain compliance with CMS and other healthcare regulations
- Complete required training on regulatory changes and adjust strategies as needed
- Identify improvement opportunities in clinical documentation and quality education programs
- Adopt and implement assigned best practices
Requirements
What you’ll need- Bachelor’s degree preferred; equivalent combination of relevant education and experience considered
- CRC or CPC certification required
- CPMA certification preferred
- 5+ years of experience in risk adjustment coding and documentation improvement queries
- Thorough understanding of risk adjustment coding, CMS-HCC Risk Adjustment Model Categorical Hierarchy, open condition reporting, unreported conditions, and readdressing open chronic conditions
- Expertise in prospective, retrospective, and concurrent review processes
- Strong knowledge of healthcare regulations, risk adjustment, quality provisions, and industry rules
- Ability to identify potential fraud and abuse in coding and documentation
- Ability to conduct comprehensive chart reviews
- Experience with provider education programs and delivery
- Ability to communicate effectively with providers individually and in groups
- Analytical, problem-identification, problem-solving, and data-analysis skills
- Proficiency in reporting and Microsoft Office tools, including Excel, PowerPoint, Word, and Outlook
- Experience with value-based care and population health platforms such as Arcadia and Salesforce preferred
- Familiarity with AI-enabled tools such as Claude preferred
- Ability to quickly learn and use internal reporting and proprietary toolsets
- Strong attention to detail and ability to meet deadlines and performance targets
- Effective communication and interpersonal skills
- Commitment to continuous learning and staying updated on industry trends
- Ability to travel frequently to provider clinic locations
- Reliable transportation for in-person interactions with local providers
Benefits
Comp & perks- Remote worker designation
- Professional development and necessary regulatory training
- Company-provided educational materials and coding tools
- Opportunity to work with Wellvana technology and solutions
- Frequent travel support through reliable transportation requirement (no travel reimbursement stated)