Coding Educator Job Description

Clinicians turn to the Coding Educator for guidance on CMS Risk Adjustment documentation, while coders and compliance auditors depend on this role to close the coding gaps surfaced in weekly inter-rater reliability reviews. Coding operations leadership expects fresh ICD-10-CM update training every year, tied directly to real audit trends rather than generic content. The role sits inside a coding education team, translating Medicare Advantage HCC scoring rules into lessons a physician can use quickly. It is a small team with big reach.

In this seat, the Coding Educator turns coder audit findings, inter-rater review results, and CMS Risk Adjustment updates into training that keeps documentation accurate and revenue integrity intact for the organization. The position reports to coding operations or quality leadership and partners closely with compliance, coders, and providers throughout each training cycle.

Career Impact: Earning CRC or CPC certification while training providers on HCC coding builds a rare combination of auditing, education, and compliance expertise.

Business Impact: Accurate CMS Risk Adjustment documentation directly protects an organization's Medicare Advantage reimbursement and lowers fraud and abuse exposure.

Growth Opportunity: Coding Educators who track audit trends and lead ICD-10-CM update training often move into compliance, quality, or coding operations leadership.

• Deliver coding and documentation training to coders, auditors, clinicians, and providers on CMS Risk Adjustment and HCC guidelines.
• Analyze coder audit trends and inter-rater review results to identify education gaps and refine training topics.
• Develop annual ICD-10-CM update training and supporting materials based on coding policy and guideline changes.
• Conduct inter-rater reliability reviews and score results to calibrate coding accuracy across the team.
• Train providers on EHR documentation workflows that support accurate coding for known and suspected risk adjustment conditions.
• Monitor coder accuracy and charge capture against ICD-10, CPT, and modifier guidelines.
• Serve as the escalation point and subject matter expert for complex risk adjustment coding and documentation questions.
• Partner with compliance and coding operations leadership to align training content with current regulatory requirements.

• Bachelor's degree in health information management, nursing, or a related field, or equivalent work experience.
• 2 or more years of medical coding or auditing experience, with a focus on ICD-10-CM and CPT coding.
• Certification as a Certified Professional Coder (CPC) or equivalent credential from AAPC or AHIMA.
• Working knowledge of CMS and AMA coding guidelines and federal and state regulations governing risk adjustment documentation.
• Strong verbal and written communication skills for delivering training to coders, auditors, and providers.
• Proficiency with Microsoft Office and electronic medical record systems used for coding and documentation review.
• Exemplary attention to detail and accuracy when reviewing medical record documentation and coding.
• Ability to work independently and exercise sound judgment on complex coding and documentation issues.

• Certified Risk Adjustment Coder (CRC) credential, reflecting specialized expertise in HCC coding, scoring, and risk adjustment audits.
• Prior experience designing coding or documentation training materials, including user guides and facilitator resources.
• Background in professional coding audits, with the ability to code directly from operative reports.
• Valid driver's license, reliable transportation, and willingness to travel for on-site provider training sessions.

• Inter-rater reliability score, measuring coding agreement consistency across the team following calibration reviews.
• Coder audit error rate, tracking how training reduces recurring documentation and coding mistakes over time.
• Annual ICD-10-CM training completion rate among assigned coders, auditors, and providers.
• Quarterly KPI attainment score for training delivery and provider education outcomes.
• Escalation response time for risk adjustment coding questions raised by providers and coders.
• Typical tools: office software (commonly Microsoft Office); records systems (commonly electronic medical record platforms and encoders).

• Base Salary Range: $65,000 to $85,000 per year, depending on certification, experience, and location
• Bonus: Annual performance bonus of 5 to 10 percent of base salary
• Equity: Equity is uncommon for this role outside larger healthcare systems
• Health Benefits: Medical, dental, and vision insurance, plus employer-sponsored retirement plan matching
• PTO: Two to four weeks of paid time off, plus standard holidays
• Common Perks: Certification exam reimbursement, continuing education credits, and remote work flexibility

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Employment is contingent upon successful completion of a background check and, where applicable, drug screening consistent with healthcare industry standards. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, or any other characteristic protected under federal, state, and local law. Reasonable accommodation under the Americans with Disabilities Act is available upon request during the application or employment process. Candidates must be authorized to work in the United States.

The Coding Educator delivers coding and documentation training on the CMS Risk Adjustment model to coders, auditors, clinicians, and CDI specialists, closing audit trend gaps identified through weekly inter-rater reviews. Reporting to Coding Operations and Education and QA leadership, the Coding Educator partners with the corporate coding education committee to keep annual ICD-10 training current and audit-driven.

Key Responsibilities

• Facilitate and deliver collaborative coding resources and targeted training with the team manager, new hires, and Coding Operations.
• Collaborate with Coding, Education, and QA Operations leadership to identify trends and gaps in coder audits for education and resource topics.
• Deliver training sessions required for Coding Policy Guideline updates and changes.
• Collaborate with Coding Operations Compliance and Quality to develop and deliver continuing education.
• Develop and deliver Annual ICD-10 update training, post-learning assessments, and apply for CEU credit from AAPC.
• Develop and deliver monthly Coder education topics for auditors, coders, CDI staff, and educators.
• Conduct weekly inter-rater reliability reviews for the coding team, collaborating with QA to identify necessary encounter visits.
• Score and collate inter-rater reliability results and provide weekly group feedback to coding teams.
• Collaborate with the Education Team to design, develop, and publish coding and documentation educational materials based on results, trends, and coding gaps.
• Apply adult learning principles using a wide variety of instructional methods and media to deliver technical content.
• Work with minimal guidance and analyze data to develop training programs based on the data.
• Work collaboratively with internal business partners to enhance the coding education program.
• Participate as an active member of the corporate coding education committee.
• Maintain knowledge of CPT and Evaluation and Management guidelines.

Required Qualifications

• Bachelor's degree in a health-related field, or equivalent education and experience.
• Coding certification from AAPC or AHIMA (CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, or CCS-P), or ICD-10-CM AHIMA-approved trainer status.
• Certified Clinical Documentation Improvement Specialist credential from ACDIS or AHIMA.
• 3 or more years of coding experience in ICD-10 and CPT or Evaluation and Management assignment.
• 2 years of experience in clinical documentation improvement queries and the Medicare Advantage Risk Adjustment HCC model.
• 2 years of experience developing and delivering coding education and training, including user guides, presentations, and facilitator guides.
• Experience leading projects and reviewing medical records.
• Extensive knowledge of local, state, and federal regulatory guidelines on coding, documentation, and fraud and abuse risk areas.
• Advanced understanding of medical terminology, pharmacology, anatomy and physiology, and disease processes.
• Proficiency in Microsoft Office and ability to learn new computer applications, including EMR systems.
• Exemplary attention to detail and completeness.
• Ability to work autonomously and meet established deadlines with limited supervision.
• Proven ability to communicate clearly, exercise independent judgment, and provide comprehensive guidance on CMS coding guidelines to providers.
• Commitment to the Standards of Ethical Coding set by AHIMA and AAPC.

Embedded within the organization's risk adjustment program, the Coding Educator leads training on the Hierarchical Condition Category model for individual providers and large provider groups, mostly delivered in person. Working closely with practice staff, health plans, and physicians across a matrixed organization, the role supports Medicare Shared Savings Program and Medicare Advantage value-based care agreements.

Core Functions

• Conduct training with individual and large provider groups, predominantly in-person, using the HCC Risk Adjustment model primarily.
• Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training.
• Execute on risk adjustment onboarding training plans with new providers in the market.
• Analyze key coding performance indicators to determine providers in need of initial or additional training.
• Identify training priorities and proactively schedule provider trainings with providers' offices, individual providers, and groups of providers.
• Train on effective EHR workflows to support coding and documentation for both known and suspected conditions.
• Provide level one support for basic EHR customer support questions specific to risk adjustment workflows.
• Meet key performance indicators and quarterly objectives.
• Act as the subject matter expert and escalation point for how providers document and code risk adjustment information in the EHR clinical record.
• Follow documentation and coding guidelines and legal requirements accurately to ensure compliance with federal and state regulatory bodies.

Qualifications & Experience

• Associate's degree required, Bachelor's degree preferred.
• Certified Professional Coder (CPC) required, with Certified Risk Adjustment Coder (CRC) highly preferred or required within one year of employment.
• Five years of experience using ICD-10-CM, with two years of experience in risk adjustment training geared toward physicians.
• Extensive knowledge of documentation and coding guidelines established by CMS and AMA for assignment of diagnostic and procedural codes.
• Expert knowledge of Federal laws and regulations, including NCDs and LCDs, affecting risk adjustment documentation and coding compliance.
• Commitment to maintaining patient, team member, and employer confidentiality in compliance with HIPAA regulations.
• Proficiency with MS Office Suite, electronic medical records, Encoder, Coding Clinic, G-Suite, and other software programs and internet-based applications needed to fulfill position duties.
• Ability to communicate effectively and have honest, difficult conversations with providers about diagnosis documentation and code assignment.
• Ability to establish and maintain effective working relationships with physicians, non-physician practitioners, practice staff, health plans, and other stakeholders.
• Excellent presentation skills to lead trainings for large groups of physicians and executives.
• Ability to use a customer-focused approach when managing conflict and resolving problems.

Reporting to coding operations leadership, the Coding Educator shapes practitioner education by auditing medical record documentation and coder charge capture accuracy against CMS coding guidelines. Partnering with department leadership, the role helps maintain the charge description master methodology to keep pricing and coding practices accurate and compliant.

Primary Duties

• Perform medical record audits, including analysis of documentation, validation of diagnoses and procedures, and proper assignment of diagnosis and procedure codes using CMS coding guidelines.
• Monitor accuracy of centralized coders' charge capture and coding with proper ICD-10, CPTs, and modifiers, adhering to the organization's practices and policies.
• Partner with leadership to improve HCC and high-risk scoring through provider and coder education.
• Conduct ongoing reviews of patient medical record documentation and procedural and diagnosis coding by each practitioner.
• Educate practitioners on coding, documentation, and compliance topics.
• Establish and modify the charge description master methodology and pricing models, working closely with leadership and the department, to ensure accuracy and regulatory compliance.

Skills & Qualifications

• High school diploma or equivalent combination of education and experience.
• Certified Professional Coder or Registered Health Information Technician required.
• 2 to 6 years of professional coding experience, including comprehensive knowledge of ICD-10, CPT, and HCPCS modifiers, prior auditing experience, and the ability to code from operative reports.
• Solid understanding of Medicare, Medicaid, Health Maintenance Organization, commercial insurance, and other third-party billing rules and regulations, along with ICD-10 and CPT coding and medical terminology.
• Ability to demonstrate competency with a standard desktop and Windows-based computer system, including e-learning and intranet navigation, and to use other software as required.
• Effective verbal, written, and interpersonal communication skills, with the ability to comfortably interact with diverse populations.
• Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation.
• Ability to handle patient and organizational information in a confidential manner, with demonstrated dependability and regular attendance.
• Capacity to maintain accurate records, prioritize and organize work effectively, and exercise independent judgment within standard practices and procedures.

Sitting at the intersection of colleague coding quality and client quality assurance compliance, the Coding Educator builds accuracy and consistency through audits of colleague-coded data and completed feedback reviews. Operating across conference calls, supervisor discussions, and error trend analysis, the role investigates client coding quality assurance questions and guides colleagues toward stronger coding accuracy.

Duties

• Review colleague-coded data to ensure quality standards and provide educational feedback to the colleague.
• Provide completed audits with feedback to the colleague and their supervisor.
• Hold conference calls with colleagues and supervisors, as needed, to discuss questions.
• Investigate client coding quality assurance questions regarding colleague-coded charts.
• Monitor and interpret colleague error trends to provide expert feedback during educational sessions.

Requirements

• AAPC certification, with a strong background in E/M and surgical coding.
• 2 or more years of professional auditing experience.
• Working knowledge of Arizona Medicaid coding guidelines.
• Experience with EMR systems.
• Demonstrated ability to maintain a high level of accuracy, even under pressure.
• Ability to multitask in a dynamic environment.
• Proficient in computer typing skills.

A key member of the coding leadership team, the Coding Educator owns tailored education plans for each assigned provider, built from in-depth medical record reviews. Collaborating across moderately complex to highly complex issues, the role influences department strategy and exercises considerable latitude in determining objectives and approaches to assignments.

Leadership Responsibilities

• Identify opportunities to improve provider documentation.
• Create an education plan tailored to each assigned provider.
• Review medical records and arrange educational sessions with providers focused on quality of care and documentation improvements.
• Analyze moderately complex to complex issues, requiring in-depth evaluation of variable factors, to determine technical approach for project components performed without direction.
• Influence department strategy on coding education initiatives, exercising considerable latitude in determining objectives and approaches to assignments.

Experience & Qualifications

• Bachelor's degree and AHIMA or AAPC CPC (Certified Professional Coder) certification required.
• 1 or more years of experience in medical coding, documentation, and provider education.
• Comprehensive knowledge of MS Word, Excel, and PowerPoint.
• Ability to problem-solve complex issues and guide business and leadership in process improvement.
• Working knowledge of medical record review procedures.
• Valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits, required under the company's driver safety program.