Providers Education Specialist

About the role

The Provider Education Specialist delivers education to internal and external clients on operational topics that improve efficiency, coding accuracy, and clinical documentation. The role supports risk‑adjustment initiatives, HEDIS measures, and other quality programs across medical offices throughout Puerto Rico.

Key responsibilities

• Assess referrals from various internal units, identify educational needs, and develop an educational plan aligned with operational goals.
• Create and deliver presentations, workshops, and training materials in‑person, by phone, virtually, or online for providers, staff, and IPA administrators.
• Visit medical offices to coach providers on best coding practices, documentation improvement, and risk‑adjustment strategies.
• Collaborate with billing, MIS, and outpatient clinic teams to validate diagnoses and ensure compliance with coding standards.
• Maintain records of all educational interventions and submit regular reports to the unit supervisor.

Required profile

• Bachelor’s degree in a health‑related field (or Associate’s degree with additional experience).
• At least 2‑4 years of experience extracting diagnoses and procedures, interpreting medical records for inpatient and outpatient coding, and delivering educational presentations.
• Valid driver’s license for Puerto Rico and willingness to travel across the island, including Vieques and Culebra.
• Intermediate proficiency in both Spanish and English.

Required skills

• Clinical coding knowledge and familiarity with coding guidelines from Medicare, AHIMA, AMA, etc.
• Medical billing concepts.