Manager, Risk Adjustment & HEDIS Education

What You'll Do

Strive Health is looking for a collaborative, provider-facing leader to own and scale provider education strategies and improve documentation quality, coding accuracy, audit readiness, and value-based performance across Strive. The Manager, Risk & HEDIS Education will partner across Risk Adjustment, Quality, Clinical Operations, Compliance, Informatics, and provider-facing stakeholders to design and deliver standardized education programs that helps providers document accurate and compliant patient complexity while supporting quality and audit readiness. This role will translate organizational priorities into provider-friendly workflows, targeted coaching, and actionable feedback that improves performance across markets. This individual would report to the Senior Director, Risk Adjustment and HEDIS Enablement.

The Day to Day

• Lead the development and delivery of provider education programs focused on risk adjustment, HCC documentation, ICD-10-CM coding principles, HEDIS quality measures, and documentation best practices for employed and contracted provider groups.
• Set goals, timelines, and performance expectations for the education initiatives and ensure work is aligned to departmental priorities, market needs, and enterprise standards.
• Serve as a primary subject matter resource to operational teams on documentation requirements, coding guidelines, CMS regulations, audit readiness, and value-based care performance expectations.
• Conduct prospective and retrospective documentation and coding reviews to identify trends, educational opportunities, provider-specific gaps, and areas for workflow improvement.
• Develop standardized education materials, feedback mechanisms, tip sheets, playbooks, and training curricula to support provider onboarding, ongoing education, and scalable adoption across markets.
• Provide targeted coaching and performance feedback to providers, provider groups, and market partners based on audit findings, documentation trends, coding reviews, and quality performance opportunities.
• Partner with Risk Adjustment, Quality, Clinical Operations, Compliance, Legal, and Coding leadership to ensure provider-facing guidance is practical, consistent, and aligned with organizational standards.
• Monitor provider, group, and market-level documentation and coding trends and develop reporting and recommendations that support accountability, continuous improvement, and stronger value-based performance.
• Support workflow and technology optimization efforts by partnering with Informatics, Product, EHR, and operational teams to embed documentation and coding requirements into provider workflows and education.
• Support change management and education for new documentation workflows, tools, and process enhancements that improve documentation quality, coding accuracy, provider experience, and operational efficiency.
• Meet in person with internal and/or external stakeholders to facilitate team and business priorities and opportunities. Business travel may be required for opportunities to connect with stakeholders, serve patients, and attend Strive-sponsored team events.

Minimum Qualifications

• Bachelor’s degree in healthcare administration, nursing, public health, health information management, healthcare management, or a related field. Equivalent combinations of education and experience may be considered.
• 4+ years of experience or certification in risk adjustment, medical coding, clinical documentation improvement, provider education, auditing, quality improvement, or related healthcare disciplines.
• Active Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) certification.
• Demonstrated experience delivering education, coaching, and training to physicians, advanced practice providers, and clinical teams.
• Strong knowledge of Medicare Advantage risk adjustment methodologies, HCC models, CMS regulations, and ICD-10-CM coding guidelines.
• Knowledge of HEDIS, Stars, quality programs, and healthcare analytics.
• Demonstrated experience analyzing documentation, coding, quality, or performance data and translating findings into targeted education and improvement strategies.
• Strong presentation, facilitation, communication, and relationship-building skills with the ability to work effectively across providers, operational leaders, network partners, and cross-functional teams.
• Ability to travel and be onsite to meet business needs.
• Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms.
• Efficient and reliable transportation, including an active driver’s license, allowing for travel across an assigned region to meet business needs.

Preferred Qualifications

• Experience supporting value-based care, population health, managed care, accountable care, or delegated provider programs.
• Experience conducting coding audits, provider feedback reviews, clinical documentation improvement initiatives, or provider performance education.
• Experience supporting EHR optimization, provider workflow redesign, or implementation of documentation support tools.
• Certified Professional Medical Auditor (CPMA), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCS-P), RHIA, RHIT, CDEO, CCDS, or CCDS-O preferred.

About You

• You are an effective educator who can translate complex coding, documentation, and regulatory requirements into clear, provider-friendly guidance.
• You are comfortable balancing relationship-building with accountability and can deliver feedback in a way that drives improvement and trust.
• You are highly organized, adaptable, and able to manage multiple priorities across provider groups, markets, and cross-functional stakeholders.
• You bring sound judgment, curiosity, and problem-solving skills and can identify practical opportunities to improve workflows, education, and performance.
• You thrive in a fast-paced, evolving environment and are motivated by building scalable programs that improve both provider experience and organizational outcomes.

Annual Base Salary Range: $85,500 - $104,000