Clinical Revenue Cycle Educator

WVU Medicine; Core (WV); On-site; USD 75,000 - 110,000; Full time

Job summary

WVU Medicine is seeking a Clinical Revenue Cycle Educator to lead systemwide training across CDI, coding, denials, and utilization review. You will develop content, deliver training, and ensure staff competency, onboarding new providers, and supporting audits and enterprise initiatives to improve quality and financial performance.

The role requires RN licensure, nursing degree, and experience in inpatient coding or revenue cycle functions.

Qualifications

• RN license in the state of practice or multi-state license via eNLC.
• Bachelor's Degree in Nursing or ASN required.
• 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.

Responsibilities

• Design and lead systemwide CDI, coding, UR, and denial management training using data‑driven curriculum and audits.
• Provide training on DRG/CPT updates, onboarding of providers and hospitals with standardized documentation.
• Offer individualized, case‑based support addressing documentation, coding, medical necessity, and appeals questions.
• Develop tip sheets, payer grids, and workflow references reflecting CMS and payer standards.
• Monitor query accuracy, DRG shifts, denials, and outcomes to drive corrective education.
• Track completion, competency, and audit trends to evaluate program impact and refine priorities.

Skills

RN license

Two years inpatient coding/CDI/denials

Three years RN experience

Education

Bachelor's Degree in Nursing or ASN

Tools

Epic

3M 360

ClinIntell

Job description

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

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the eNLC.
• Bachelor's Degree in Nursing or Associate of Science in Nursing (ASN).
• 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.

Preferred Qualifications

• One of the following certifications: Certified Coding Specialist (CCS) through AHIMA; Certified Clinical Documentation Specialist (CCDS) through ACAIS; Certified Documentation Improvement Practitioner (CDIP) through AHIMA; Health Care Quality and Management Certification (HCQM) through ABQA and UR Physicians; Accredited Case Manager (ACM) through ACMA; Certified Case Manager (CCM) through Commission for Case Manager Certification.
• Five (5) years in a hospital revenue cycle role with exposure to multiple functions (coding, CDI, UR).
• Three (3) years of direct educator/trainer experience designing and delivering clinical or operational training programs.
• Hands‑on experience with appeals, payer communication, and denial prevention strategies.

Core Duties and Responsibilities

• 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.

Physical Requirements

• Must be able to sit for long periods of time.
• Must have visual and hearing acuity within the normal range.
• Must have manual dexterity needed to operate computer and office equipment.

Working Environment

• Standard office environment.
• May be exposed to standard patient care environment.
• Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.
• May require travel.

Skills & Abilities

• Advanced knowledge of CDI, coding, UR, and revenue cycle operations.
• Strong teaching, presentation, and facilitation skills.
• Skilled in interpreting audit results and translating them into education.
• Ability to work collaboratively across departments and communicate with physicians, nurses, coders, and revenue cycle staff.
• Strong organizational and problem‑solving skills.
• Knowledge of Medicare/Medicaid regulations, payer policies, and the Two‑Midnight Rule.
• Strong understanding of denial management, CDI workflows, and HIM compliance.
• Demonstrated ability to develop curriculum, lead training, and present complex concepts to diverse audiences (physicians, nurses, coders, revenue cycle staff).
• Proficiency in Epic, 3M 360, ClinIntell, and revenue cycle analytics tools preferred. Excellent communication, facilitation, and change management skills.