Position Summary
The APRN - Provider Education Specialist is responsible for delivering education, coaching, and performance support to Advanced Practice Providers (APRNs/PAs) and Physicians to enhance clinical documentation accuracy, risk adjustment capture, and quality outcomes in a value-based care environment. This role serves as a clinical subject matter expert in HCC documentation, CMS risk adjustment guidelines, and quality measures, translating regulatory and clinical requirements into practical, provider-focused education.
The Provider Education Specialist partners closely with Clinical Affairs, Quality, Coding, and Operations teams to support provider performance, compliance, and improved patient outcomes across the organization.
Key Responsibilities
Required Qualifications
Preferred Qualifications
Core Competencies
The APRN - Provider Education Specialist is responsible for delivering education, coaching, and performance support to Advanced Practice Providers (APRNs/PAs) and Physicians to enhance clinical documentation accuracy, risk adjustment capture, and quality outcomes in a value-based care environment. This role serves as a clinical subject matter expert in HCC documentation, CMS risk adjustment guidelines, and quality measures, translating regulatory and clinical requirements into practical, provider-focused education.
The Provider Education Specialist partners closely with Clinical Affairs, Quality, Coding, and Operations teams to support provider performance, compliance, and improved patient outcomes across the organization.
Key Responsibilities
- Develop and deliver onboarding and ongoing education for APRNs, PAs, and Physicians related to risk adjustment, quality measures, and documentation standards.
- Provide training on HCC capture, diagnosis specificity, chronic condition documentation, and annual reassessment requirements.
- Translate CMS, ICD-10, and organizational requirements into clear, clinically relevant guidance for providers.
- Educate providers on compliant documentation practices aligned with Medicare Advantage and CMS standards.
- Reinforce best practices to support accurate risk representation and continuity of care.
- Collaborate with Coding and Clinical Documentation Improvement (CDI) teams to address audit findings, documentation gaps, and trends.
- Train providers on quality metrics, preventive care standards, and chronic disease management expectations.
- Support initiatives focused on care gap closure, quality score improvement, and patient outcomes.
- Provide targeted coaching based on performance dashboards, audits, and quality reports.
- Build strong, collaborative relationships with providers across disciplines.
- Conduct one-on-one and group coaching sessions to reinforce expectations and drive performance improvement.
- Serve as a trusted clinical education resource for documentation, risk adjustment, and quality-related questions.
- Review provider performance data, audit results, and quality reports to identify education opportunities.
- Partner with leadership to develop targeted education plans and improvement strategies.
- Track training effectiveness and recommend enhancements to education content and delivery.
Required Qualifications
- Active, unrestricted APRN license
- Minimum 3 years of clinical practice experience
- Demonstrated knowledge of:
- Risk adjustment and HCC documentation
- Medicare Advantage and value-based care models
- Clinical documentation improvement (CDI)
- Strong communication, facilitation, and coaching skills
Preferred Qualifications
- Experience training or mentoring providers
- Background in Quality, Risk Adjustment, Population Health, or CDI
- Familiarity with CMS guidelines, RADV audits, and quality programs
- Experience working in a multi-site or medical group environment
Core Competencies
- Provider education and adult learning principles
- Clinical documentation expertise
- Risk adjustment and quality knowledge
- Influence without authority
- Data-driven coaching and problem solving
- Relationship building and provider engagement