DRG Clinical and Coding Educator

🕒 September 16

🤠 Texas – Remote

🤠 Texas – Remote

💵 $86.8k - $115k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Develop and deliver training programs for DRG auditors, coders, CDI teams, clinicians, and physicians • Create and maintain coding education materials, presentations, webinars, and training content • Serve as an ICD-10, DRG validation, and coding guidelines subject matter expert • Mentor and coach clinical teams to ensure audit and coding accuracy • Analyze quality trends and training needs and provide targeted education • Monitor quality metrics and implement educational improvements • Ensure training content complies with coding guidelines, regulations, and clinical policies • Maintain documentation of training activities and accreditation requirements • Support clinical claim reviews, quality audits, and appeals as needed • Maintain expertise in coding, clinical review processes, workflows, and industry standards • Partner with Operations, Quality, and Leadership teams to identify educational needs, address knowledge gaps, and support continuous quality improvement

🎯 Requirements

• Associate degree in Health Information Management, Nursing, Clinical Sciences or related healthcare fields required • Current, active and unencumbered Registered Nurse License • Inpatient Coding Certification (CCS, CIC, CCDS, CDIP, CPMA, RHIA, RHIT) • Minimum of 5 years experience in inpatient claims auditing, quality assurance, or clinical documentation integrity • Minimum of 5 years of experience performing DRG Validation Audits and inpatient coding, with extensive experience in APR DRG and MS DRG • 3+ years of experience developing education programs related to healthcare policy, Medicare guidelines, and State regulation research and interpretation • 5+ years of professional medical coding experience, including coding education, training, quality review, and audit activities • Experience applying inpatient hospital and outpatient facility coding and billing rules • Understanding of clinical claims review audit techniques and identifying overpayments/underpayments or revenue opportunities

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Benefits effective on Day 1 • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies