Hybrid Clinical Nurse Supervisor: Claims & Coding Lead

Gainwell Technologies; Mississippi; Hybrid; USD 85,000 - 100,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Educational assistance

Flexible vacation policy

Leadership and development academies

Job summary

Gainwell Technologies is seeking a Clinical Nurse Supervisor to lead a team of RNs and coding professionals in clinical claims processing. You will ensure compliant adjudication, drive performance, and collaborate with providers and leadership to achieve operational excellence.

The role is full-time, hybrid, with on-site work in Jackson, MS during onboarding, and flexible hours thereafter. A strong nursing background with coding knowledge is essential for success.

Qualifications

• Active, unrestricted RN license in Mississippi or Compact State/NLC.
• 5+ years of experience reviewing and adjudicating clinical or medical claims.
• 3+ years in DRG (Inpatient) and OPPS/APC (Outpatient) payment methodologies.
• Experience with CPT, HCPCS, and ICD coding, coding compliance, and reimbursement systems.
• Knowledge of Medicare, Medicaid, regulatory requirements, and InterQual or Milliman guidelines.
• Demonstrated ability to apply clinical judgment and make clinical determinations.
• 3+ years of leadership experience managing clinical teams and driving performance.

Responsibilities

• Lead daily clinical operations for RNs and coding professionals, ensuring productivity, quality, compliance, and goals.
• Manage clinical claims review and processing activities, including medical necessity reviews and audits.
• Ensure accurate, timely, and compliant claims processing per payer policies and CMS Mississippi Medicaid.
• Oversee CPT, HCPCS, and related coding functions, ensuring regulatory compliance and QA.
• Monitor performance metrics, SLAs, coding accuracy, and financial outcomes; develop dashboards.
• Analyze data to identify trends, denial causes, and education opportunities.
• Lead quality, compliance, risk management including HIPAA audits and corrective actions.
• Collaborate with providers, clients and teams to improve efficiency and outcomes.

Skills

RN license

Coding certifications

DRG/OPPS knowledge

CPT/HCPCS/ICD coding

Medicare/Medicaid knowledge

Clinical judgment

Leadership experience

Data analysis

Education

Associate Degree in Nursing (ADN)

Bachelor's degree in Nursing, Healthcare Administration, Business Administration, or related field

Job description

Gainwell Technologies is seeking a Clinical Nurse Supervisor to lead a team of RNs and coding professionals in clinical claims processing. You will ensure compliant adjudication, drive performance, and collaborate with providers and leadership to achieve operational excellence.

The role is full-time, hybrid, with on-site work in Jackson, MS during onboarding, and flexible hours thereafter. A strong nursing background with coding knowledge is essential for success.