Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
Position Overview
The Clinical Trainer is responsible for delivering structured training programs for offshore clinicians supporting clinical review (e.g., utilization management, case review, abstraction) and medical coding workflows. This role ensures learners develop strong clinical judgment, accurate documentation practices, and coding proficiency required to support high-quality clinical and coding outcomes.
The trainer will lead new hire training, uptraining programs, and ongoing skill development, ensuring alignment with clinical criteria, coding guidelines, quality standards, and productivity expectations.
This role collaborates closely with Operations, Quality Assurance, and Client Stakeholders to maintain clinical accuracy, coding compliance, and overall readiness of clinicians handling end-to-end case evaluation.
Clinical Trainer
Key Responsibilities
Training Delivery
- Facilitate new hire training programs covering:
- Clinical review workflows (UM, case review, abstraction)
- Medical necessity evaluation and criteria interpretation
- Clinical documentation standards
- ICD-10, CPT, and HCPCS coding systems
- System navigation and operational procedures
- Deliver uptraining modules, including but not limited to:
- Complex and high-risk case reviews
- Appeals and edge-case clinical scenarios
- Documentation-driven coding accuracy
- Specialty-specific scenarios (e.g., inpatient, outpatient, oncology)
- Conduct case-based discussions to reinforce clinical judgment, documentation accuracy, and coding application
Curriculum Development
- Develop and update training materials based on:
- Clinical guidelines and medical necessity criteria
- Coding standards and regulatory updates
- Standard Operating Procedures
- QA feedback and error trends
- Translate clinical and coding requirements into practical learning tools, including:
- Case simulations
- Clinical review and coding exercises
- Job aids and quick reference guides
- Ensure training materials remain aligned with client requirements and compliance standards
Clinical Rounds & Knowledge Integration
- Participate in and facilitate Clinical Rounds sessions to:
- Reinforce clinical reasoning and case interpretation
- Bridge gaps between clinical review, documentation, and coding outcomes
- Standardize understanding of complex and specialty cases
- Convert Clinical Rounds insights into:
- Training enhancements
- Case libraries and simulation scenarios
- Frequently Asked Questions (FAQs) and job aids
Competency Assessment
- Design and administer training assessments including:
- Knowledge checks
- Clinical scenario evaluations
- Coding and documentation exercises
- Track trainee performance and maintain training scorecards and readiness reports
- Ensure trainees meet required quality and accuracy thresholds prior to certification
Quality, IRR & Performance Alignment
- Partner with Quality Assurance teams to:
- Identify clinical and coding error trends
- Incorporate audit feedback into training modules
- Conduct targeted refresher sessions
- Participate in Inter-Rater Reliability (IRR) activities, including:
- Calibration sessions to ensure consistency in clinical interpretation and coding application
- Alignment with QA, Operations, and client reviewers on case decisions
- Supporting IRR improvement initiatives through targeted training interventions
- Ensure alignment of training outputs with quality benchmarks and audit expectations
Post-Training Support
- Support nesting and ramp phases by:
- Monitoring trainee performance
- Providing coaching and remediation
- Conducting refresher training where required
- Assist operations leadership in reducing clinical errors, coding inaccuracies, and rework
Stakeholder Collaboration
- Work closely with:
- Operations leadership
- Client stakeholders
- Quality teams
- Provide regular updates on training outcomes, learner readiness, IRR alignment, and performance improvement opportunities
Minimum Qualifications
Education
- Clinician (RN or allied health professional preferred)
Certification
- Active coding certification required (CPC, CCS, or equivalent)
Experience
- Over 2 years of experience in:
- Clinical review (UM, case management, or abstraction) and medical coding
- Minimum 1 year experience in training, coaching, or SME roles
- Experience participating in calibration sessions, audits, or IRR activities preferred
Knowledge
- Clinical review processes and medical necessity criteria
- ICD-10, CPT, and HCPCS coding systems
- Clinical documentation and case review standards
- Coding compliance and audit requirements
- Understanding of IRR principles and quality calibration processes
Key Skills
Clinical & Coding Skills
- Strong clinical judgment and decision-making capability
- Ability to connect clinical findings with coding outcomes
- High attention to detail in documentation and coding accuracy
- Ability to identify documentation gaps impacting both review and coding
Training Skills
- Adult learning facilitation
- Classroom and virtual training delivery
- Assessment design and learner evaluation
- Coaching and mentoring capabilities
Technical Skills
- Proficiency with Microsoft Office tools
- Experience with clinical review, coding, or abstraction platforms
- Ability to navigate multiple systems simultaneously
Competency
- Clinical Judgment and Decision Support
- Coding Accuracy and Compliance
- Instructional Facilitation
- Attention to Detail
- Analytical Thinking
- Communication and Presentation Skills
- Stakeholder Collaboration
- Continuous Learning and Improvement
Working Conditions
- Onsite work at Sagility delivery center
- May support early or late shifts depending on training schedules
- Coordination with US-based stakeholders
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