Medicare Risk Adjustment Educator- Greater Sarasota

MaxHealth is hiring a Medicare Risk Adjustment who will be responsible for improving the accuracy, specificity, and compliance of clinical documentation and diagnosis coding across MaxHealth' s Medicare Advantage population. The role pairs hands-on education with analytics: the Educator teaches physicians, advanced practice providers, and the internal coding team how to document and code chronic conditions to the highest level of specificity supported by the medical record and uses performance data to identify which providers need targeted coaching and which charts require additional validation through review.

Candidates must have at least 3 years of experience and have flexibility for local travel within Sarasota/Manatee County as needed for Provider Education tasks in clinic.

Normal hours of operation are Monday- Friday 8:00am-5:00 pm.

• →Provider Education - Design and deliver documentation and coding education to physicians and advanced practice providers, both one-on-one and in group settings. Sessions cover the CMS-HCC risk adjustment model, MEAT and DSP documentation standards, condition specificity, annual recapture of chronic conditions, and the documentation elements that support each diagnosis submitted.
• →Data Analysis and Chart Review - Analyze provider-level coding and documentation performance to determine where additional validation is warranted. Review suspect and gap reports, recapture and persistence rates, coding accuracy and audit results, and diagnosis submission patterns to build a prioritized list of providers to engage in additional education. Findings are summarized for Risk Adjustment leadership with a clear recommendation: targeted education, focused chart review support, or both.
• →Workflows- Work fluently within the electronic medical record to abstract documentation, validate diagnoses against the record, and review encounter notes, problem lists, and supporting clinical data. Use EMR reporting and risk adjustment platform tools (Salesforce) to prepare for education sessions and recommend workflow or template updates that make accurate documentation easier at the point of care.
• →Compliance - Ensure that all education and review activity complies with CMS risk adjustment guidance, official ICD-10-CM coding guidelines, and MaxHealth compliance policy. The standard is documentation that is complete, specific, and defensible on audit.

• Active Certified Risk Adjustment Coder (CRC) certification through AAPC or Certified Coding Specialist (CCS) certification through AHIMA, in good standing required at the time of hire.
• Minimum of three years of clinical documentation and coding experience, including hands-on Medicare risk adjustment or HCC coding.
• Demonstrated ability to work within electronic medical record systems to abstract, validate, and review clinical documentation.
• Comfort and credibility delivering education directly to physicians and advanced practice providers, in person and virtually.
• Experience training, mentoring, or auditing a coding team.
• Working knowledge of the CMS-HCC risk adjustment model, official ICD-10-CM coding guidelines, and CMS documentation and audit standards.
• Ability to analyze coding and documentation performance data to determine which providers require additional validation through chart review, and to present those findings clearly to leadership.
• Proficiency with spreadsheets and reporting tools for tracking accuracy, recapture, and audit outcomes.
• Willingness and ability to travel routinely to practice and clinic sites within the region of coverage responsibility; valid driver's license and reliable transportation.
• Strong written and verbal communication skills, including the ability to deliver constructive feedback to clinicians and sustain working relationships afterward.

This healthcare position earns a competitive wage, depending on experience. We provide fantastic benefits, including health benefits, a 401k plan, life insurance, long-term disability, paid holidays, and PTO (paid time off)!

ABOUT MAXHEALTH

MaxHealth is dedicated to simplifying healthcare and ensuring healthier futures-for our patients and our people.

Founded in 2015, MaxHealth is a leading primary care platform focused on delivering high‑quality, integrated, value‑based care to adults and senior patients throughout Florida. Today, we support more than 70,000 value‑based care patients through a growing network of more than 55 owned clinics and 30 affiliated practices across central and southern Florida.

Our success is driven by our people. MaxHealth is home to a diverse, multidisciplinary team of more than 700 employees-including primary care providers, specialists, clinical staff, and corporate professionals-who are united by a shared purpose: to make healthcare simpler, more compassionate, and more human.

We are proud to offer a workplace that supports career growth, internal advancement, and work‑life balance, with regular weekday office hours and a strong commitment to employee well‑being.

At MaxHealth, team members are encouraged to grow their skills, pursue leadership opportunities, and build long‑term careers in an environment where their contributions truly matter.

MaxHealth also partners with like‑minded independent providers, leveraging our platform to expand access to high‑quality care while preserving the personalized relationships that define great medicine.

Our values guide everything we do: we are customer‑centered, compassionate, results‑driven, proactive, collaborative, and adaptable. These values shape not only how we care for patients, but how we support one another as colleagues.

Our mission is simple: to deliver quality care, a simplified experience, and happiness-one patient, and one team member, at a time.

#IND123