Job Purpose
The
Academe Inpatient Medical Coding QA Educator is responsible for elevating coding accuracy and compliance through targeted education driven by QA findings. This role bridges quality assurance and training by designing evidence-based curricula, leading corrective coaching, and monitoring knowledge application across inpatient coders. The Educator ensures alignment with official guidelines (ICD-10-CM/PCS, UHDDS, POA) and payer-specific rules, supports rebuttal resolution, and drives sustained performance improvement reflected in reduced error rates and improved DRG integrity.
Key Responsibilities
Education Program Design & Delivery
- Develop and deliver structured education plans based on QA audit trends (e.g., principal diagnosis selection, MCC/CC capture, PCS root operations, device qualifiers, sequencing rules, POA indicators).
- Create modular learning content (micro-lessons, job aids, case-based workshops, checklists, reference packs) for targeted gaps.
- Facilitate 1:1 coaching and small group sessions, incorporating live case simulations and retrospective chart reviews.
QA Integration & Continuous Improvement
- Perform QA reviews on assigned coding samples to ensure accuracy, compliance, and adherence to client-specific guidelines.
- Analyze audit outcomes to identify error patterns, contributing factors, and root causes; translate findings into actionable education.
- Validate error classification, consistency, and hierarchy application; support rebuttal assessment with evidence-based rationale.
- Maintain and update an education backlog tied to high-impact error clusters and payer denials.
Compliance & Standards
- Ensure all training aligns with ICD-10-CM/PCS Official Guidelines, CMS MS-DRG grouping logic, UHDDS definitions, Coding Clinic guidance, POA reporting, and facility- or payer-specific policies.
- Monitor guideline changes and cascade updates, update materials and sessions in a timely manner.
Performance Monitoring & Reporting
- Define and track education effectiveness metrics (pre/post assessments, error rate deltas, DRG change rates, denial events, audit pass rates).
- Publish weekly/monthly dashboards on education outcomes and risk hotspots; present at Ops/QA touchpoints.
- Partners with Operations leads to schedule education without disrupting throughput, coordinating follow-ups and reinforcement plans.
Stakeholder Collaboration
- Work closely with QA Supervisors, Operations Managers, Trainers, and onshore clients to align on expectations, sampling, glidepaths, and timelines.
- Contribute to playbook standardization across accounts, support rollout of QA forms, templates, and rebuttal workflows.
Required Qualifications- Education: Bachelor's degree in a health-related field (e.g., Nursing, Allied Health, HIM) or equivalent experience.
- Certifications: Must have CCS/CIC certification.
- Experience:
- Solid 3 years of Inpatient DRG QA experience.
- Demonstrated experience designing and delivering coder education based on QA data.
Preferred Skills & Competencies
- Coding Expertise: Strong command of principal diagnosis selection, MCC/CC capture, PCS approach/device/qualifier logic, sequencing, POA assignment, UHDDS definitions, and DRG validation.
- QA & Analytics: Error taxonomy, root cause analysis, sampling strategies, rebuttal review, trend analysis.
- Tools: Proficiency with encoder/groupers, EHR/chart review tools, QA dashboards (Excel/Sheets), and documentation platforms (Word/Docs, PPT).
- Communication: Clear written and verbal communication; ability to explain complex rules simply; confident facilitation across geographies.
- Collaboration & Planning: Stakeholder alignment, change management, time management, and organized follow-through.
Key Performance Indicators (KPIs)
- Reduction in targeted error rates (e.g., PDx selection, MCC/CC misses, PCS assignment).
- Improvement in audit pass rates.
- DRG stability/accuracy (fewer inappropriate DRG shifts post-education).
- Denial reduction tied to education focus areas.
- Education delivery against agreed glidepaths and remediation SLAs.
- Positive coder feedback and measurable post-training assessment gains.
Working Conditions
- Schedule: Standard business hours with flexibility for cross-geo collaboration.
- Work Mode: Remote
- Data Security: Strict adherence to HIPAA-equivalent privacy and organizational confidentiality policies.
