Provider Educator, Stars & Risk Adjustment

The Provider Educator, Stars and Risk Adjustment serves as a key clinical leader focused on improving quality outcomes, documentation accuracy, and performance in Medicare Star Ratings and Risk Adjustment. This role works collaboratively across the organization to identify opportunities, implement strategic initiatives, and strengthen clinical workflows that support compliant, high-quality value-based care.

• Analyze clinical, quality, and performance data to identify areas of opportunity and develop actionable plans to address identified gaps
• Review clinical and coding integrity analytically derived nuances including, but not limited to, single source diagnoses, acute chronic conditions, and outlier percentages, for appropriate next steps of education, change in claims, or otherwise 
• Educate respective parties of findings for ongoing education materials of the company holistically and at individual level 
• Develop sustainable processes and key areas to look for within charts and the analytics to allow for local markets to identify and evaluate risks 
• Identify, synthesize, and present review findings, trends, and recommendations to key stakeholders to ensure shared understanding and alignment on appropriate next steps
• Serve as a subject matter expert in clinical and coding guidelines, ensuring the medical group remains current and compliant with regulatory requirements
• Assist in the development and advancement of the overall quality program, including Stars and Risk Adjustment and the expansive quality needs of the group to appropriately assess patient care
• Identify and resolve operational barriers when met with conflicting and compromising business initiatives across the organization
• Establish and recommend additional monitoring and insights to safeguard documentation accuracy, completeness, and overall clinical performance 

• Bachelor’s degree or equivalent combination of education and/or experience
• Active and unrestricted clinical license – LPN, RN, NP, PA, MD, DO or related field
• Coding certificate required (CPC, CRC, CCS, or equivalent)
• Minimum of three (3) years of experience in Medicare Star Rating and Risk Adjustment
• Demonstrated ability to work in a matrix environment and influence others
• Proficiency in data analysis and development
• Experience performing retrospective and/or prospective chart reviews
• Ability to translate clinical and coding findings into actionable feedback for clinicians and operational partners
• Written and verbal communication skills, including presentation of findings to diverse stakeholders.
• Experience developing and implementing action plans to address quality or documentation gaps

• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
• Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
• Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave
• Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts 

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.  

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. 

Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.