Provider Educator (Coding Coordinator)

Job description

Education, Training, Content Development, Regulatory Updates
• Facilitate comprehensive onboarding for new providers to ensure a strong foundation in billing, coding, and documentation requirements.
• Deliver timely updates to stakeholders (providers, coders, departments, RevCycle, leadership) on legislative, regulatory, coding, billing, and documentation changes.
• Identify training needs and collaborate on the development and delivery of educational programs and materials tailored to specific audiences.
• Maintain and expand the centralized Resource Library, ensuring easy access to accurate and up-to-date educational materials.
• Provide ongoing education, feedback, and support to enhance compliance and accuracy in documentation, coding, and billing.
• Translate complex coding, billing, and regulatory information into user-friendly, accurate educational materials.
• Create and deliver presentations tailored to specific internal and external audiences, ensuring relevance and clarity, and addresses the needs of the stakeholders.
• Monitor and analyze changes in industry regulations, payor policies, CPT codes, and compliance requirements.
• Develop and deliver education sessions to ensure stakeholders stay informed of evolving standards and regulations.

Audits, Reviews, and Projects
• Conduct provider audits and routine departmental audits for hospital-based (HB) and professional-based (PB) coding.
• Perform risk-based audits, including reviews of outliers, denial trends, and upcoding/downcoding patterns.
• Lead proactive audits (e.g., RAC, TPE, OIG, CBR) to identify and mitigate compliance risks.
• Conduct ad hoc audit and other review requests from coding teams, providers, departments, leadership, and RevCycle, providing actionable feedback and recommendations.
• Planned and special projects as assigned.
• Other ongoing work related to education, billing, coding, documentation, etc.
• Execute various projects, from ad hoc to long-term, by developing problem statements, defining scope, and managing timelines and resources to ensure successful outcomes.
• Support colleagues with projects and engage in mentorship opportunities to build team knowledge and skills.
• Work on strategic initiatives, such as automation, denial prevention, and billing for underutilized services (e.g., care management, telehealth).

Advisory, Assistance, Advocacy, and Collaboration
• Serve as a resource for resolving complex coding queries, disputes, and documentation challenges.
• Research and respond to inquiries from providers and coders, offering clear and actionable guidance.
• Develop and update policies, guidelines, and workflows for coding, documentation, and billing to ensure compliance and efficiency.

Mentorship and Team Development
• Provide mentorship and guidance to junior team members, supporting their professional development and knowledge growth.
• Foster a collaborative and supportive environment within the Provider Education team.

Other duties as assigned
• Associates degree in Healthcare, Business or related field; AND
• 5 years of production coding experience; OR
• Equivalent combination of education and experience.
• Certification in CPC, CPC-H, RHIT, or RHIA.

Knowledge, Skills, and Abilities
• Strong knowledge of coding guidelines, regulations, and documentation requirements.
• High degree of coding accuracy and ability to retain and appropriately apply multiple complex coding concepts.
• Intermediate skills with Word, Excel, Outlook, and PowerPoint.
• Excellent communication, presentation, and interpersonal skills.
• Willingness to be on camera and appropriately attired for all online meetings.
• Proficiency in educational program development and delivery.
• Familiarity with healthcare compliance principles.
• Experience with electronic health records (EHR).
• Commitment to staying current with industry developments and continuous learning.
• Bachelor’s in related healthcare field.
• 5+ years of auditing and provider or coder education experience in multiple specialties.
• Additional certifications.
• Associates degree in Healthcare, Business or related field; AND
• 5 years of production coding experience; OR
• Equivalent combination of education and experience.
• Certification in CPC, CPC-H, RHIT, or RHIA.

Knowledge, Skills, and Abilities
• Strong knowledge of coding guidelines, regulations, and documentation requirements.
• High degree of coding accuracy and ability to retain and appropriately apply multiple complex coding concepts.
• Intermediate skills with Word, Excel, Outlook, and PowerPoint.
• Excellent communication, presentation, and interpersonal skills.
• Willingness to be on camera and appropriately attired for all online meetings.
• Proficiency in educational program development and delivery.
• Familiarity with healthcare compliance principles.
• Experience with electronic health records (EHR).
• Commitment to staying current with industry developments and continuous learning.
• Bachelor’s in related healthcare field.
• 5+ years of auditing and provider or coder education experience in multiple specialties.
• Additional certifications.