Outpatient Coding Auditor, Senior Associate

Gainwell Technologies; Massachusetts; Remote; USD 48,000 - 69,000; Full time

Job summary

An established industry leader is seeking a Senior Associate Outpatient Coding Auditor to join their innovative team. In this role, you will leverage your extensive coding expertise to perform detailed audits of medical records, ensuring compliance with official coding guidelines and regulations. This position offers the flexibility of remote work, allowing you to balance your professional and personal life while contributing to meaningful healthcare solutions. With a commitment to continuous learning and career advancement, this company provides a supportive environment where your skills can flourish. Join a team that values collaboration, innovation, and inclusivity, and take the next step in your career with a firm dedicated to making healthcare work better for everyone.

Benefits

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership development academies

Technical development academies

Qualifications

• Extensive background in inpatient or outpatient coding required.
• Demonstrated proficiency in ICD-10 CM, ICD-10-PCS coding.

Responsibilities

• Perform audits of medical records for coding accuracy.
• Assist in training new Coding Auditors and maintain coding knowledge.

Skills

ICD-10 coding expertise

Medical record auditing

Knowledge of reimbursement guidelines

Proficiency in coding methodology

Education

Coding certification

3+ years of coding experience

Tools

HMS proprietary auditing systems

Job description

Date: Apr 17, 2025

Location: Any city, MA, US, 99999

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. 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. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

We are seeking a talented individual for an Outpatient Coding Auditor, Senior Associate who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in either facility-based inpatient coding and/or outpatient coding edits and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG, ASC and APC payment systems.

What you will do

1. Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding expertise to substantiate conclusions. Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
2. Consistently achieves productivity and quality performance standards established by management.
3. Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
4. Assists management with training new Coding Auditors to include daily monitoring, mentoring, feedback and education.
5. Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.
6. Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
7. 3+ years coding inpatient or outpatient claims; required.
8. Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
9. Demonstrates a thorough understanding of the APR-DRG, AP-DRG, and MS-DRG.
10. Demonstrated experience in medical record coding and auditing.

What you should expect in this role

1. Remote (work from home) environment.
2. Benefits on first day of employment.
3. Clear path advancement with training and leadership.
4. In order to effectively work as a teleworker with Gainwell, employees should have a minimum Broadband Internet connection speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.

The pay range for this position is $48,000.00-$68,600.00 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.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.