Provider Education Specialist

APRN – Provider Education Specialist

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