Remote DRG Quality Advisor Nurse — Flexible Hours

Talanto; Northern (KY); Hybrid; USD 90,000 - 110,000; Full time

Benefits offered by this job

401(k) employer match

Comprehensive health benefits

Flexible vacation policy

Job summary

Gainwell seeks a DRG Quality Advisor Nurse for a remote role within the continental United States. You will perform quality assurance audits, validate DRG coding, review medical records, and ensure determinations align with guidelines and methodologies.

The role requires RN licensure, coding certification, and 5+ years inpatient experience. You will document findings, mentor reviewers, and stay current with coding guidelines.

Qualifications

• Active, unrestricted RN license in the United States.
• 3+ years MS-DRG/APR-DRG coding or auditing experience.
• Expert knowledge of ICD-10-CM/PCS coding and DRG methodologies.
• Strong clinical audit and documentation skills.

Responsibilities

• Perform quality assurance checks on final review work for complex clinical claims and DRG validation reviews of medical record documentation.
• Review and analyze claim data and medical record documentation using approved clinical review methodologies and coding guidelines.
• Apply clinical review judgment and DRG reimbursement knowledge to make accurate determinations.
• Document audit findings, rationales, and supporting evidence clearly in systems.

Skills

RN licensure US

DRG/MSC-DRG knowledge

MS-DRG/APR-DRG experience

ICD-10-CM/PCS expertise

Clinical auditing

Education

RN license (US)

Coding Certifications (RHIA/RHIT/CCS/CIC/CCDS/CPC)

Job description

Gainwell seeks a DRG Quality Advisor Nurse for a remote role within the continental United States. You will perform quality assurance audits, validate DRG coding, review medical records, and ensure determinations align with guidelines and methodologies.

The role requires RN licensure, coding certification, and 5+ years inpatient experience. You will document findings, mentor reviewers, and stay current with coding guidelines.