Senior DRG Coding Quality Auditor – Remote

Gainwell Technologies; Town of Texas, Northern (WI, KY); Hybrid; USD 79,000 - 105,000; Full time

Benefits offered by this job

Generous vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a DRG quality auditor with RN licensure to perform outpatient coding and DRG validation reviews. You will access systems to audit medical records, document findings, and support policy/regulatory determinations.

The role emphasizes DRG methodologies, chart audits, and mentorship across coders and reviewers. This remote, full-time position requires extensive auditing experience and strong written communication.

Qualifications

• Active, unrestricted RN licensure in the US is required.
• Preferred coding certifications: RHIA, RHIT, CCS, CIC, CPMA, CCDS or CPC.
• 3+ years MS DRG/APR DRG coding or outpatient auditing experience.
• Expert ICD-10-CM coding knowledge including CCs/MCCs and SOI/ROM.
• Expert ICD-10-PCS coding methods, sequencing, and CMS guidance.
• Ability to apply clinical review judgment to determinations.
• Strong written communication to justify review determinations.
• Advanced medical coding knowledge and quality improvement experience.

Responsibilities

• Perform QA audits of final review outcomes for accuracy and documentation.
• Identify quality trends, develop corrective actions and training content.
• Audit records to validate diagnoses and procedure codes per guidelines.
• Conduct outpatient coding reviews and quality audits.
• Document review determinations clearly for reporting and trending.
• Train and mentor new coders and reviewers.
• Stay current on DRG methodologies and client review requirements.
• Attend trainings and contribute to process improvements.

Skills

RN licensure

DRG coding

ICD-10-CM coding

Medical record audits

Written communication

Job description

Gainwell Technologies is seeking a DRG quality auditor with RN licensure to perform outpatient coding and DRG validation reviews. You will access systems to audit medical records, document findings, and support policy/regulatory determinations.

The role emphasizes DRG methodologies, chart audits, and mentorship across coders and reviewers. This remote, full-time position requires extensive auditing experience and strong written communication.