Associate Manager, Inpatient/Outpatient Coding Review

Job not on LinkedIn

🔥 27 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $85k - $109.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Supervise the quality review program, creating policies and processes relating to quality and ensuring continuous conformance with appropriate standards, regulations, and contractual agreements. • Develop, implement, and maintain quality assurance processes and performance benchmarks for DRG validation, inpatient coding, and outpatient coding/billing audits. • Supervise and mentor clinical auditors and coding specialists; provide education, coaching, and performance feedback. • Monitor and report key performance indicators (KPIs) for audit accuracy, productivity, and interrater reliability. • Identify trends, root causes, and opportunities for improvement in documentation or coding accuracy. • Analyze audit results, denial trends, and payer findings to identify systemic issues and recommend corrective actions. • Prepare and present regular reports and dashboards for leadership, highlighting performance metrics, audit outcomes, and improvement initiatives. • Support compliance and revenue integrity efforts by ensuring the accuracy of coded data used for reimbursement, quality reporting, and analytics. • Develop and deliver training programs for coding, clinical, and quality assurance teams. • Stay current with evolving CMS regulations, ICD-10-CM/PCS updates, and industry standards for inpatient coding and DRG assignment. • Drive continuous quality improvement initiatives to enhance effectiveness and efficiency. • Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; act as a resource for resolving escalated issues, and coach and mentor staff to develop a high-performing team. • Manage and evaluate individual and team performance, and take appropriate action to meet and/or exceed performance standards. • Perform other functions as assigned.

🎯 Requirements

• At least one of the following active Coding Certifications is required and is to be maintained as a condition of employment: RHIA, RHIT, CCS, CIC, CCDS or CPC • 5+ years inpatient or outpatient coding/auditing required • Working knowledge of ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, CPT coding and DRG reimbursement methodologies strongly preferred • Bachelor’s degree in business, healthcare administration, or related field preferred • 2+ year’s management or supervisory experience preferred

🏖️ Benefits

• generous, flexible vacation policy • a 401(k) employer match • comprehensive health benefits • educational assistance • various leadership and technical development academies