Clinical Educator; Remote

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Clinical Educator, Mid to join our growing team.

Job Summary:

The purpose of this position is to provide coding and medical necessity education to hospital stakeholders related to Higher-Weighted DRG (HWDRG) and medical necessity reviews conducted by Acentra Health. This role educates hospitals on coding and medical necessity errors identified during reviews, clarifies correct billing and documentation practices, and supports hospitals in determining next steps to reduce future errors and improve compliance with Medicare requirements.

Responsibilities:

• Develop and deliver targeted educational programs for hospitals identified as having high error rates related to inpatient coding and medical necessity determinations.
• Analyze HWDRG and medical necessity review findings to identify coding, documentation, and utilization trends, root causes, and education needs.
• Prepare and maintain presentations, reference materials, and educational tools focused on ICD-10-CM/PCS coding, DRG assignment, and medical necessity requirements.
• Provide education to hospital coding, CDI, utilization management, compliance, and revenue cycle teams, as appropriate.
• Educate hospitals on CMS medical necessity standards, appropriate inpatient admission criteria, and documentation expectations.
• Maintain data and metrics to evaluate the effectiveness of education efforts and provide meaningful reports to leadership.
• Perform quality assurance audits or focused reviews, as requested, to identify ongoing coding and medical necessity gaps.
• Collaborate with internal clinical, coding, and operations teams to ensure consistent, CMS-aligned education and messaging.
• Cross-train and assist with other BFCC review activities, as needed, to support workforce flexibility.
• Read, understand, and adhere to all corporate policies, including those related to HIPAA Privacy and Security Rules.

This list of responsibilities is not intended to be all-inclusive and may be expanded based on program needs and leadership direction.

Required Qualifications

• Demonstrated inpatient coding experience, including ICD-10-CM and ICD-10-PCS.
• Current coding certification, such as CCS, CIC, or equivalent.
• Minimum of three (3) years of inpatient hospital coding experience, including DRG assignment.
• Strong knowledge of medical necessity criteria, inpatient admission standards, and Medicare billing requirements.
• Proven ability to educate adult learners on complex coding and medical necessity concepts.
• Strong written and verbal communication skills.

Preferred Qualifications

• Experience with HWDRG validation, medical necessity reviews, or utilization management reviews.
• Familiarity with CMS regulations, Medicare Conditions of Participation, and compliance standards.
• Experience educating hospital coding, CDI, utilization management, or revenue cycle teams.
• Knowledge of adult learning principles and instructional design.
• Prior experience working in a BFCC QIO, Medicare Administrative Contractor (MAC), payer, or auditing environment.
• Previous workload or project management experience.

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health…