Associate Manager, Inpatient/Outpatient Coding Review

🕒 July 29

🇺🇸 United States – Remote

💵 $85k - $109.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 23%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 a multidisciplinary team of Certified Coders, Clinical DRG Auditors, and Nurse Reviewers • Audit inpatient and outpatient medical records to determine correct coding according to contract-specific methodologies • Create quality policies and processes and ensure conformance with 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 • Mentor clinical auditors and coding specialists through education, coaching, and performance feedback • Monitor and report KPIs for audit accuracy, productivity, and interrater reliability • Identify trends, root causes, and improvement opportunities in documentation and coding accuracy • Analyze audit results, denial trends, and payer findings to identify systemic issues and recommend corrective actions • Prepare and present reports and dashboards for leadership • Support compliance and revenue integrity efforts by ensuring coded-data accuracy for reimbursement, quality reporting, and analytics • Develop and deliver training programs for coding, clinical, and quality assurance teams • Stay current with CMS regulations, ICD-10-CM/PCS updates, and inpatient coding and DRG assignment standards • Drive continuous quality improvement initiatives • Serve as a subject matter expert for new tools, automation, product development, and clinical readiness • Resolve escalated issues and develop a high-performing team • Manage and evaluate individual and team performance and take appropriate action to meet or exceed standards • Perform other assigned functions

🎯 Requirements

• At least one active Coding Certification required and maintained as a condition of employment: RHIA, RHIT, CCS, CIC, CCDS, or CPC • 5+ years of inpatient or outpatient coding/auditing experience • 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+ years of management or supervisory experience preferred • Must have a work location within the continental United States • Must provide a high-speed internet connection and distraction-free work environment • Ability to work during normal business hours • May be required to work extended hours for special business needs • May be required to travel at least 10% of the time based on business needs

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Home-based work arrangement • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Potential extended-hours compensation or benefits are not specified • Travel expense-related benefits may be available, but are not specified