Clinical Revenue Cycle Educator

Role Overview

• Design and lead systemwide CDI, coding, UR, and denial management training using data-driven curriculum, competency assessments, and audit outcomes to improve accuracy, compliance, and preventable denials.
• Provide focused training on DRG/CPT updates, clinical criteria, and payer policies; support onboarding of new providers and hospitals with standardized documentation and utilization expectations.
• Offer individualized, case-based support to staff and providers, addressing real-time documentation, coding, medical necessity, and appeals questions.
• Develop concise tip sheets, payer grids, documentation guides, and workflow references that reflect current CMS and payer standards.
• Equip providers with clear guidance on admission criteria, medical necessity documentation, peer-to-peer expectations, and high-risk payer issues.
• Monitor query accuracy, status determinations, DRG shifts, downgrades, and overturned denials; ensure findings drive corrective education.
• Review internal/external audits to identify documentation, coding, or utilization gaps; deliver targeted education based on root causes.
• Develop a coordinated, enterprise-wide education roadmap aligned with regulatory updates, audit trends, and CRC strategic priorities.
• Collaborate with UR/CDI/Denials/RI leaders to interpret payer rules and create targeted training that reduces preventable denials.
• Use insights from ClinIntell, CloudMed, Solventum, and Epic reports to focus education on high-impact conditions, DRGs, and denial patterns.
• Gather frontline feedback, translate operational challenges into education updates, and ensure consistent cross-facility communication.
• Develop cross-functional education modules that reinforce LOS optimization, DRG integrity, denial prevention, and Epic workflow standardization.
• Provide expert guidance to directors, physicians, and executives on documentation integrity, medical necessity, and denial mitigation.
• Track completion, competency, audit scores, and denial trends to evaluate program impact and refine future education priorities.
• Deliver concise, data-driven summaries of progress, gaps, and recommendations to CRC leadership and CFO councils.

Requirements

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
• Must Hold at Least One of the Following Certifications: Certified Coding Specialist (CCS) through American Health Information Management Association (AHIMA).
• Certified Clinical Documentation Specialist (CCDS) through Association of Clinical Documentation Integrity Specialists.
• Certified Documentation Improvement Practitioner (CDIP) through American Health Information Management Association (AHIMA).
• Health Care Quality and Management Certification (HCQM) through American Board of Quality Assurance and Utilization Review Physicians.
• Accredited Case Manager (ACM) through American Case Management Association.
• Certified Case Manager (CCM) through Commission for Case Manager Certification.
• Two (2) years of experience in inpatient acute care coding, CDI, Denials, Utilization Review, or Appeals.
• Three (3) years of RN experience in a nursing or clinical role.

Benefits

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.