DRG Clinical & Coding Educator

This is a fully remote position, open to applicants in United States.

📋 Description

• Design and implement training programs for DRG auditors and clinical review personnel.

• Educate coders, CDI teams, and healthcare providers on documentation standards, coding practices, and DRG classification.

• Develop and update training resources, presentations, and educational materials.

• Act as a subject matter expert in ICD-10-CM/PCS, coding standards, and DRG validation processes.

• Offer coaching, mentoring, and continuous education to enhance team performance.

• Partner with clinical and quality teams to assess training needs and enhance outcomes.

• Track quality metrics and execute focused educational interventions.

• Ensure training materials adhere to coding regulations, guidelines, and clinical policies.

• Maintain training documentation and uphold accreditation standards.

• Conduct clinical claim evaluations, coding audits, and manage appeals when necessary.

⛳️ Requirements

• An associate degree in Health Information Management, Nursing, Clinical Sciences, or a related healthcare discipline is required.

• A current, active, and unencumbered Registered Nurse (RN) license is necessary.

• Inpatient Coding Certification is required: CCS, CIC, CCDS, CDIP, CPMA, RHIA, or RHIT.

• At least 5 years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity is required.

• A minimum of 5 years of experience conducting DRG validation audits and inpatient coding is necessary.

• Comprehensive experience with both APR-DRG and MS-DRG is essential.

• Over 3 years of experience in creating educational programs related to healthcare policy, Medicare guidelines, and state regulatory research and interpretation.

• More than 5 years of professional medical coding experience, including coding education, training, quality review, and audit responsibilities.

• Experience with inpatient hospital and outpatient facility coding and billing regulations.

• Strong knowledge of clinical claims review auditing methods, including identifying overpayments, underpayments, and opportunities for revenue enhancement.

• Up to 10% travel may be required.

• A bachelor's degree is preferred.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning opportunities.

• Career development prospects.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Up to 10% travel may be required.