DRG Clinical and Coding Educator- Remote

Gainwell Technologies LLC; Ohio; Remote; USD 86,000 - 115,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Educational assistance

Generous vacation policy

Job summary

Gainwell Technologies LLC is seeking an experienced DRG Clinical & Coding Educator to develop, coordinate, and deliver comprehensive training for clinical reviewers, DRG validators, and inpatient/outpatient coding auditors. You will serve as the subject matter expert for DRG validation, APR-DRG, MS-DRG, ICD-10-CM/PCS guidelines, and auditing methodologies.

You will provide onboarding and ongoing education to maintain coding accuracy, clinical competency, and compliance with industry standards,

Qualifications

• Onboarding and ongoing education to ensure staff coding accuracy.
• Ability to mentor clinical teams for audit and coding accuracy.
• Experience with DRG validation, APR-DRG, MS-DRG.
• Knowledge of ICD-10-CM/PCS coding guidelines.

Responsibilities

• 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.
• 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.

Skills

DRG Audits

Trainer / Education Delivery

Quality Analytics

Auditing & Coding Compliance

Clinical Documentation Improvement (CD

Education

Associates degree in Health Information Management, Nursing, Clinical Sciences or related healthcare fields

Bachelor’s Degree preferred

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. Gainwell 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.

• 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.
• 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.

• Associates degree in Health Information Management, Nursing, Clinical Sciences or related healthcare fields required, Bachelor’s Degree preferred.
• 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, inpatient coding, with extensive experience in APR DRG as well as MS DRG.
• 3+ years of experience with developing education programs related to healthcare policy, Medicare guidelines and State regulation research and interpretation.
• 5+ years of professional medical coding experience, including experience supporting 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, identifying overpayments/underpayments, or other identification of revenue opportunities

Remote within the U.Full-time position

The pay range for this position is $86,800.00 - $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. 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.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.