SummaryGainwell Technologies is seeking an experienced and innovative DRG Clinical & Coding Educator who is responsible for developing, coordinating, and delivering comprehensive training programs for clinical reviewers, DRG validators, and inpatient/outpatient coding auditors. This role serves as the subject matter expert for DRG validation, APR-DRG, MS-DRG, assignment, ICD-10-CM/PCS coding guidelines, clinical documentation requirements, and payment integrity audit methodologies.
The DRG Clinical & Coding Educator provides onboarding and ongoing education to ensure staff maintain a high level of coding accuracy, clinical competency, audit consistency, and compliance with industry standards. This position partners closely with Operations, Quality, and Leadership teams to identify educational needs, address knowledge gaps, and support continuous quality improvement initiatives.
Your role in our mission- Develop and deliver training programs for DRG auditors and clinical review staff.
- Train coders, CDI teams, and physicians on documentation, coding, and DRG assignment.
- Create and maintain training materials, presentations, and educational content.Serve as an SME on ICD-10-CM/PCS, coding guidelines, and DRG validation.
- Provide coaching, mentoring, and ongoing education to support team performance.
- Collaborate with clinical and quality teams to identify training needs and improve outcomes.
- Monitor quality metrics and implement targeted educational interventions.
- Ensure training content complies with coding guidelines, regulations, and clinical policies.
- Maintain training documentation and accreditation standards.
- Perform clinical claim reviews, coding audits, and appeals as needed.
What we're looking for- Associate degree in Health Information Management, Nursing, Clinical Sciences, or a related healthcare field required; Bachelor's degree preferred.
- Current, active, and unencumbered Registered Nurse (RN) license required.
- Inpatient Coding Certification required (CCS, CIC, CCDS, CDIP, CPMA, RHIA, or RHIT).
- Minimum of 5 years of 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 both APR-DRG and MS-DRG.
- 3+ years of experience developing educational programs related to healthcare policy, Medicare guidelines, and state regulation research and interpretation.
- 5+ years of professional medical coding experience, including supporting coding education, training, quality review, and audit activities.
- Experience applying inpatient hospital and outpatient facility coding and billing rules.
- Strong understanding of clinical claims review audit techniques, including identifying overpayments, underpayments, and other revenue enhancement opportunities.
What you should expect in this role- Location: Remote within the United States
- Travel: Up to 10% travel required
- Employment Type: Full-time
The application period will remain open through September 18.
The pay range for this position is $86,000.00 - $115,000.00 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.
