Remote Lead: Outpatient Coding Quality Auditor

Gainwell Technologies; Town of Texas (WI); Hybrid; USD 60,000 - 86,000; Full time

Benefits offered by this job

Health benefits

401(k) matching

Paid time off

Job summary

Gainwell Technologies is seeking a Lead Associate, Outpatient Coding Quality Auditor for a remote US position. The role conducts complex coding quality reviews of medical records to validate accuracy, reimbursement, and client methodologies, serving as a subject matter expert in outpatient coding.

The position requires AHIMA/AAPC credentials, 3+ years in outpatient coding and audits, expertise in EAPG, APC, ASC systems, and the ability to lead QA initiatives, train staff, and drive improvements

Qualifications

• Active AHIMA or AAPC credentials required.
• 3+ years outpatient medical record coding experience.
• 3+ years auditing, QA, or validation experience.
• Extensive experience with outpatient claims and records.

Responsibilities

• Conduct complex coding quality reviews of medical records.
• Apply contract-specific methodologies to identify discrepancies.
• Evaluate documentation to ensure coding assignments are compliant.
• Document audit findings and recommendations using systems.
• Provide coding and reimbursement determinations with supporting docs.
• Perform ongoing QA audits of staff for accuracy and consistency.
• Interpret and apply coding guidelines, CMS rules, and NCCI edits.
• Assess performance against quality and productivity standards.
• Identify opportunities for process improvements and corrective actions.
• Participate in IRR and calibration sessions to promote consistency.
• Develop quality monitoring tools and review protocols.
• Serve as a subject matter expert on outpatient coding.
• Achieve productivity and quality targets set by management.

Skills

Outpatient coding

Auditing

Regulatory compliance

Quality assurance

Leadership

Education

AHIMA or AAPC CPC/COC/CCS/RHIA/RHIT credential

3+ years outpatient medical record coding

3+ years coding auditing/QA/validation

Experience reviewing outpatient facility claims

Job description

Gainwell Technologies is seeking a Lead Associate, Outpatient Coding Quality Auditor for a remote US position. The role conducts complex coding quality reviews of medical records to validate accuracy, reimbursement, and client methodologies, serving as a subject matter expert in outpatient coding.

The position requires AHIMA/AAPC credentials, 3+ years in outpatient coding and audits, expertise in EAPG, APC, ASC systems, and the ability to lead QA initiatives, train staff, and drive improvements