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Clinical Documentation Educator- HCC Risk Adjustment Coder Job in West Palm Beach, Florida

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Job Title: Clinical Documentation Educator- HCC Risk Adjustment Coder

Employer:Pinnacle Healthcare Management Services
Skills:HCC Risk Adjustment Coding and Educator
Specialties:Primary Care, Medicare Advantage Risk Adjustment
Required Certifications:CDI,RHIT,CRC,CPC,CCS-P,CCS,RHIA; CPMA is a plus
Preferred Certifications:CCS,CCS-P,CPMA,CPC,CDI,CRC
Required Experience:1 to 2 years
Preferred Experience:1 to 2 years
Location:2326 S Congress Avenue, Suite 2D West Palm Beach 33406, FL, US
Date Posted:10/30/2020

The Medicare Risk Adjustment Coder/Educator is responsible for delivering a comprehensive clinical documentation and coding education program relevant to the Medicare Advantage Plan. This individual will collaborate with the Performance Improvement and ACO departments to ensure that the curriculum is maintained in accordance with Plan expectations and meets the Medicare program regulations and coding guidelines as set forth by the Centers for Medicare and Medicaid Services. This individual will be responsible to lead the delivery of a standardized HCC, HEDIS, and quality related education curriculum as a foundation of coding guidance supporting Medicare Advantage and Traditional Medicare FFS lines of business, lead large and small group education sessions in Palm Beach County Market, identify opportunities to improve provider documentation, and deliver customized provider-specific education as needed.

Demonstrates Competency in the Following Areas:

Perform chart reviews to identify definitive diagnoses and respective codes

Provide group instruction with providers and office staff to address concepts identified by the Educator

Provide one-on-one instruction with providers and/or office staff to address concepts identified by the Educator

Integrate with the provider and their staff to identify process improvement opportunities Skills And Competencies


On-site review and analysis of provider documentation with an eye toward compliance with CMS rules and regulations to capture risk adjusting (HCC) diagnoses

Develop a customized education plan for each assigned provider to address opportunities for clinical document improvements identified during the review

Connect providers and office staff with additional Health Plan resources and support as needed


Maintain strong knowledge of ICD-10-CM diagnostic coding

Organization Requirements

Reports safety and risk issues.

Presents in a professional manner; meets appearance policy standards; wears name badge on duty.

Completes regulatory and annual requirements in a timely manner.

Reports to work on time and as scheduled; completes work within designated time.

Performs other duties as assigned or required, is willing to help in other departments and take on additional tasks. 


Regulatory Requirements:

  • HS Diploma/GED required; AA degree or higher preferred or equivalent job-related experience
  • Possess at least one of the following professional certifications: CPC, CRC, CCS, CCS-P, CDI, RHIT, RHIA; CPMA wand/or CPC-I is a plus
  • Minimum of 4 years of HCC coding experience
  • Minimum of 2 years of direct provider interaction


Practice Teamwork:

Participates in decision-making and process improvement, regardless of position in the organization.


Communicates effectively, verbal and written, during every encounter, shares information in a timely and respectful manner, facilitates successful handoffs.


Treats everyone ethically, fairly, compassionately and without judgment. 


Demonstrates Competency in the Following Areas:

Computer proficiency (including MS Windows, MS Office, and the Internet);

Knowledge of HIPAA, recognizing a commitment to privacy, security and confidentiality of all medical chart documentation.

Valid driver’s license with ability to travel locally up to 90% of time in the West Palm Beach, Florida.

Local travel to physician offices required – must have a reliable vehicle.

Ability to work from company’s West Palm Beach location when not traveling to physician offices.



Patricia Sanz

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