Coding Education Consultant - Remote

About the Role

This position reports to the Provider Education and Escalations Manager. The Coding Education Consultant is part of a team responsible for conducting coding audits for escalated claims and providing coding education to providers and facilities who are inaccurately billing. This role will primarily focus on presenting medical coding content on common billing errors, performing audits on escalated claims, and providing feedback on completed claim audits.

You will deliver coding education in a variety of settings both internally and externally, including educational boot camps, expo events, provider/facility offices, and virtual meetings (e.g., WebEx). You'll enjoy the flexibility to work remotely from anywhere within the U.S.

Responsibilities

• Create and deliver presentation materials to facilitate provider education.
• Lead provider education meetings to drive issue resolution, including potential onsite provider meetings.
• Apply principles of adult learning and training best practices to deliver effective and innovative training material.
• Create supporting materials for learning activities (e.g., agendas, schedules, letters, audio/visual aids).
• Leverage and modify existing training solutions to meet current needs.
• Act as a subject matter expert for internal and external partners, assisting with medical coding, documentation requirements, and industry standards.
• Ensure adherence to state and federal mandates for all coding guidance, applicable benefit language, medical and reimbursement policies, coding requirements, and relevant clinical information.
• Possess strong decision-making skills on complex claim audits.
• Analyze and interpret claims data and medical records to understand historical activity and determine the validity of payment/denial on a claim.
• Identify aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommend providers for review.
• Maintain and manage daily assignments with accountability to quality, utilization, and productivity standards.
• Collaborate with UHN advocacy, UHC PPS, and analysts before approaching provider calls.
• Maintain positive provider and network relationships.
• Actively own and resolve issues for Best in Class and/or high-profile providers encountered during education sessions.
• Analyze data trends prior to education outreach to ensure provider billing errors are addressed holistically.
• Manage individual workload with a high emphasis on quality.
• Assume additional responsibilities as assigned.

Requirements

• Current, active, unrestricted Inpatient Coder Certification (CIC, CCS, RHIT, RHIA, etc.).
• 5+ years of experience as a Certified Inpatient Coder in a healthcare setting, including knowledge of industry terminology and regulatory guidelines.
• 3+ years providing formal training on medical coding and/or customer service experience.
• Fully proficient with MS products such as Word, PowerPoint, and Excel (including Pivot Tables).

Preferred Qualifications

• A current, active, unrestricted nursing license (RN, LPN, etc.).
• Training Certification.
• CDI Certification.
• Managed care experience.
• Investigational and/or auditing experience.
• Knowledge of claims platforms.

Skills

• Demonstrated written, verbal, analytical, organizational, time management, and problem-solving skills.
• Proven ability to work independently.

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. Pay is based on several factors including local labor markets, education, work experience, and certifications.