Hybrid RN Clinical Claims Supervisor

Gainwell Technologies LLC; Jackson (MS); Hybrid; USD 85,000 - 100,000; Full time

Job summary

Gainwell Technologies seeks a Clinical Nurse Supervisor to lead a team of nurses and coding professionals responsible for clinical claims processing and review. You will ensure accurate, timely, and compliant adjudication of clinical claims in accordance with regulatory requirements and payer guidelines.

As a key liaison among clinical staff, coding specialists, claims operations, and leadership, you will drive collaboration, efficiency, and overall departmental performance while promoting

Qualifications

• Active, unrestricted RN license is required.
• Experience in clinical claims review and medical necessity determinations.
• Knowledge of DRG, OPPS/APC payment methodologies and InterQual/Milliman criteria.
• Active coding certifications (RHIA, RHIT, CCS, CIC, CCDS, CPC).
• Proficiency with CPT, HCPCS, ICD coding principles, coding compliance, and audits.
• Proven experience leading clinical and/or coding teams.
• Strong knowledge of Medicare, Medicaid, CMS, HIPAA and payer guidelines.
• Excellent analytical, communication, and problem-solving skills.
• Commitment to quality, compliance, and continuous improvement.

Responsibilities

• Lead clinical and coding teams to ensure accurate and timely claims review and coding operations.
• Drive regulatory compliance and high-quality service in line with payer guidelines.
• Collaborate with Medical Directors, Claims Operations, Provider Relations, and leadership to resolve complex claim issues.
• Monitor productivity, quality, compliance, and service-level performance metrics.
• Support audits, regulatory reviews, and process improvement initiatives.
• Use data-driven insights to support informed decision-making and resource management.

Skills

RN license

Clinical claims review

Medical necessity determinations

DRG & OPPS/APC methods

InterQual / Milliman criteria

CPT / HCPCS / ICD coding

Coding audits

Medicare / Medicaid / CMS / HIPAA

Team leadership

Analytical / communication / problem‑s

Education

RHIA

RHIT

CCS

CIC

CCDS

CPC

Job description

Gainwell Technologies seeks a Clinical Nurse Supervisor to lead a team of nurses and coding professionals responsible for clinical claims processing and review. You will ensure accurate, timely, and compliant adjudication of clinical claims in accordance with regulatory requirements and payer guidelines.

As a key liaison among clinical staff, coding specialists, claims operations, and leadership, you will drive collaboration, efficiency, and overall departmental performance while promoting