Professional Coding Provider Educator & Reviewer

Job Title : Professional Coding Provider Educator & Reviewer Location : System Business Office Department Name : HIM - Professional Req : 0000219981 Status : Salaried Shift : Day Pay Range : $75,597.00 - $106,780.00 per year Pay Transparency : The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience. Job Overview : The Professional Coding Provider Educator / Reviewer is responsible for preparing educational materials and delivering instruction to Medical Group physicians, Advance Practice Providers, and staff across all RWJBH medical centers, as directed by the System Professional Provider Education Coding Manager and Coding Leadership. Education may be provided in response to compliance reviews, physician onboarding, proactive training, or coding and regulatory updates. This role also conducts medical record coding audits to support education needs, including one-on-one instruction for physicians or staff. Education is delivered in person and remotely as directed. This candidate may support coding operations, including vendor productivity oversight, denial analysis, workqueue management, and efficiency of coding edits and rule sets in Epic. This blended role is accountable for improving coding quality, reducing denials, and ensuring enterpriseâ€'wide consistency in coding policy and practice. The candidate must demonstrate advanced knowledge of CPT, HCPCS, and ICD-10 guidelines, review annual and quarterly coding updates, and research newly implemented guidance to respond to coding inquiries accurately and in a timely manner. Education is delivered in person or remotely, and attendance records are maintained and submitted to management at regular intervals. This job description is not exhaustive; duties and responsibilities may change with organizational needs. Qualifications : Required : Associate's degree or equivalent experience required. CPC , or COC required; credentials must be maintained for continued employment. CPMA required or willing to obtain within 6 months of onboarding. Advanced working knowledge of CPT, HCPCS, and ICDâ€'10â€'CM Official Guidelines and comprehensive understanding of E / M coding, NCCI edits, modifier usage, and payerâ€'specific policies. Demonstrated ability to interpret and apply official coding guidance (CPT Assistant, AHA Coding Clinic, CMS manuals); familiarity with NCDs / LCDs, CMS guidance, and OIG Work Plan items. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) required. Working knowledge of claim scrub processes, coding edits, unbilled account monitoring, vendor productivity / quality metrics, and denial management workflows. Excellent verbal, written, and interpersonal communication; strong organizational skills; attention to detail; ability to prioritize multiple tasks, meet deadlines, and work independently and collaboratively in a fast-paced environment. Commitment to maintaining and sharing a centralized repository of coding references, timely response to coding inquiries, accurate documentation of interactions, and ongoing credential maintenance. Preferred : CPB, CEMC, or CPC I (AAPC approved instructor) strongly preferred. Minimum five years of professional coding and / or billing experience preferred, including demonstrated experience in provider education, auditing or physician coding reviews, E / M coding, and denial management or revenue cycle exposure. Experience with coding and clinical platforms (3M, EncoderPro, Epic) preferred. Scheduling Requirements : Full-Time, Salaried position- 37.5 hours a week The successful candidate must have the flexibility to report on-site as needed to support operational or business priorities, including education delivery and meeting attendance. Ability to deliver education in person and remotely; some travel for onâ€'site support may be required. Essential Functions : Education Prepare, develop, and deliver coding, documentation, and billing education enterpriseâ€'wide, including onboarding, proactive training, complianceâ€'driven topics, and specialtyâ€'specific updates. Create annual and quarterly CPT, HCPCS, and ICDâ€'10â€'CM updates and specialty modules; incorporate redacted record examples with citations to authoritative guidance. Design and present education informed by audit findings, compliance reviews, physician requests, and Steering Committee direction. Deliver oneâ€'onâ€'one coaching and smallâ€'group instruction for providers and staff; maintain and submit attendance records and followâ€'up documentation to management. Audit and Quality Review Perform professional fee coding and documentation audits across outpatient and inpatient settings to assess accuracy and compliance of CPT, ICDâ€'10â€'CM, HCPCS codes, modifiers, and units. Complete assigned provider reviews per the Physician Review Work Plan, document findings clearly, and prepare audit summary reports and performance dashboards. Provide detailed written and verbal feedback tied to authoritative sources; log and track audit outcomes and corrective education. Identify documentation and coding risk areas, recurring trends, and potential compliance issues; escalate complex or highâ€'risk findings to the System Professional Coding Quality and Review Manager or Compliance. Operations and Denials Support Monitor professional fee work queues, unbilled accounts, and claim scrub activities to support timely claims submission and adherence to billâ€'hold timelines. Track vendor coder productivity and quality metrics; escalate operational concerns and coordinate remediation with vendor partners and leadership. Support the Denials Team by researching codingâ€'related denials, documenting root causes, and implementing targeted and proactive education to reduce recurrence. Maintain and update coding edits, rule sets, and workflows in Epic and other coding platforms to improve claim accuracy and decrease denials. Policy, Research, and Support Research newly implemented guidance and authoritative resources (CPT Assistant, AHA Coding Clinic, CMS publications); apply and share official guidance enterpriseâ€'wide. Develop, document, implement, and maintain standardized coding policies, procedures, and a centralized repository of coding references and regulatory guidance. Respond to coding inquiries via the Coding Support inbox and other operational channels; provide referenced responses, log inquiries, and analyze trends to inform education and policy updates. Collaborate with providers, affiliate staff, internal coding teams, Compliance, revenue cycle stakeholders, and external organizations as needed to resolve coding issues and advance enterprise consistency. Reporting and Continuous Improvement Prepare and submit regular reports of educational activities, attendance, audit outcomes, operational metrics, and denial trends to management. Contribute to internal quality improvement initiatives and performance dashboards; recommend corrective actions and measure education and operational impact. Other duties as assigned. Other Duties : Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Benefits and Perks : At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees' physical, emotional, social, and financial health. Paid Time Off (PTO) Medical and Prescription Drug Insurance Dental and Vision Insurance Retirement Plans Short & Long Term Disability Life & Accidental Death Insurance Tuition Reimbursement Health Care / Dependent Care Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more! Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. Equal Opportunity Employer LI-BM1