Clinical Revenue Cycle Educator

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The Clinical Revenue Cycle Educator provides leadership, coordination, and delivery of training programs across clinical revenue cycle functions, including CDI, coding, denials and utilization review. This position is responsible for developing educational content, conducting training, facilitating feedback loops, and maintaining staff competency to ensure accuracy, compliance, and efficiency. The Educator plays a critical role in new provider onboarding, ongoing education, internal audits, and supporting enterprise initiatives that improve quality and financial performance.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate degree in Health Information Management, Nursing, another clinical/healthcare field.

2. 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.

Certified Professional in Utilization Management (CPUM) 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.

EXPERIENCE:

1. Five (5) years of experience in inpatient acute care coding, CDI, Denials, Utilization Review, or Appeals.

2. Five (5) years of RN experience in a nursing or clinical role.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in health information management, Nursing, or a related clinical field.

EXPERIENCE:

1. Seven (7) years in a hospital revenue cycle role with exposure to multiple functions (coding, CDI, UR).

2. Three (3) years of direct educator/trainer experience designing and delivering clinical or operational training programs

3. Hands-on experience with appeals, payer communication, and denial prevention strategies.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. 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.

2. 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.

3. Offer individualized, case-based support to staff and providers, addressing real-time documentation, coding, medical necessity, and appeals questions.

4. Develop concise tip sheets, payer grids, documentation guides, and workflow references that reflect current CMS and payer standards.

5. Equip providers with clear guidance on admission criteria, medical necessity documentation, peer-to-peer expectations, and high-risk payer issues.

7. Monitor query accuracy, status determinations, DRG shifts, downgrades, and overturned denials; ensure findings drive corrective education.

8. Review internal/external audits to identify documentation, coding, or utilization gaps; deliver targeted education based on root causes.

9. Develop a coordinated, enterprise-wide education roadmap aligned with regulatory updates, audit trends, and CRC strategic priorities.

10. Collaborate with UR/CDI/Denials/RI leaders to interpret payer rules and create targeted training that reduces preventable denials.

11. Use insights from ClinIntell, CloudMed, Solventum, and Epic reports to focus education on high-impact conditions, DRGs, and denial patterns.

12. Gather frontline feedback, translate operational challenges into education updates, and ensure consistent cross-facility communication.

13. Develop cross-functional education modules that reinforce LOS optimization, DRG integrity, denial prevention, and Epic workflow stan