Clinical Revenue Cycle Educator

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⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• 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.