SummaryWe are seeking a talented individual for an Associate Manager, Inpatient/Outpatient Coding Review who is responsible for supervising a multidisciplinary team of Certified Coders, Clinical DRG Auditors, and Nurse Reviewers to audit inpatient and outpatient medical records to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This role plays a critical part in identifying coding discrepancies and recoverable claim opportunities, and supporting regulatory integrity on behalf of our clients.
Your role in our mission- 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.
What we're looking for- 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
What you should expect in this role- Home based position and you must have a work location within the continental US
- This position requires that you provide high speed internet connection and a work environment free from distractions
- Ability to work during normal business hours as this position requires frequent interactions with the team and other departments within the company
- May be required to work extended hours for special business needs
- May be required to travel at least 10% of time based on business needs
The application period will remain open until September 4, 2026.
The pay range for this position is $85,000.00 - $109,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
