Hybrid RN Supervisor: Clinical Claims & Coding Leadership

Gainwell Technologies; Mississippi; Hybrid; USD 65,000 - 93,000; Full time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a Clinical Nurse Supervisor in Mississippi to lead a team of registered nurses and coding professionals responsible for clinical claims review and coding operations. This role ensures accurate, timely, and compliant adjudication of clinical claims while fostering collaboration across clinical, coding, and provider teams.

You will drive quality, productivity, and regulatory compliance, support audits, and contribute to continuous improvement initiatives.

Qualifications

• Active, unrestricted RN license.
• Experience in clinical claims review and medical necessity determinations.
• Knowledge of DRG, OPPS/APC and InterQual/Milliman criteria.
• Active coding certification (RHIA, RHIT, CCS, CIC, CCDS, or CPC).
• Experience with CPT, HCPCS, and ICD coding principles and audits.
• Proven leadership of 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, operational excellence, and continuous improvement.

Responsibilities

• Lead clinical and coding teams to deliver operational excellence.
• Ensure accurate, timely, and compliant clinical claims decisions.
• Collaborate with Medical Directors, Claims Operations, Provider Relations, and leadership to resolve issues.
• Monitor productivity, quality, compliance, and service-level performance metrics.
• Support audits, regulatory reviews, and process improvement initiatives.
• Foster collaboration across clinical, operational, provider, and leadership teams.
• Drive data-driven decisions and responsible healthcare resource management.
• Contribute to a culture of accountability, integrity, and professional development.

Skills

Active RN license

Clinical claims review

Medical necessity determinations

DRG knowledge

OPPS/APC knowledge

InterQual/Milliman criteria

Coding certification

CPT/HCPCS/ICD coding

Leadership of teams

Medicare/Medicaid/HIPAA expertise

Analytical/problem-solving skills

Quality/compliance focus

Job description

Gainwell Technologies is seeking a Clinical Nurse Supervisor in Mississippi to lead a team of registered nurses and coding professionals responsible for clinical claims review and coding operations. This role ensures accurate, timely, and compliant adjudication of clinical claims while fostering collaboration across clinical, coding, and provider teams.

You will drive quality, productivity, and regulatory compliance, support audits, and contribute to continuous improvement initiatives.