Note: The job is a remote job and is open to candidates in USA. Gainwell Technologies is seeking an experienced DRG Clinical & Coding Educator to develop, coordinate, and deliver training for clinical reviewers, DRG validators, and coding auditors. The role serves as a subject matter expert in DRG validation, ICD-10-CM/PCS coding, clinical documentation, and payment integrity, while supporting staff education, quality improvement, and audit activities.
Responsibilities
- Develop and deliver training programs for DRG auditors and clinical review staff
- Train coders, CDI teams, and physicians on documentation, coding, and DRG assignment
- Create and maintain training materials, presentations, and educational content.Serve as an SME on ICD-10-CM/PCS, coding guidelines, and DRG validation
- Provide coaching, mentoring, and ongoing education to support team performance
- Collaborate with clinical and quality teams to identify training needs and improve outcomes
- Monitor quality metrics and implement targeted educational interventions
- Ensure training content complies with coding guidelines, regulations, and clinical policies
- Maintain training documentation and accreditation standards
- Perform clinical claim reviews, coding audits, and appeals as needed
Skills
- Associate degree in Health Information Management, Nursing, Clinical Sciences, or a related healthcare field required
- Current, active, and unencumbered Registered Nurse (RN) license required
- Inpatient Coding Certification required (CCS, CIC, CCDS, CDIP, CPMA, RHIA, or RHIT)
- Minimum of 5 years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity
- Minimum of 5 years of experience performing DRG validation audits and inpatient coding, with extensive experience in both APR-DRG and MS-DRG
- 3+ years of experience developing educational programs related to healthcare policy, Medicare guidelines, and state regulation research and interpretation
- 5+ years of professional medical coding experience, including supporting coding education, training, quality review, and audit activities
- Experience applying inpatient hospital and outpatient facility coding and billing rules
- Strong understanding of clinical claims review audit techniques, including identifying overpayments, underpayments, and other revenue enhancement opportunities
- Location: Remote within the United States
- Travel: Up to 10% travel required
- Employment Type: Full-time
- Bachelor's degree
Benefits
- More flexible hours
- Work-life balance
- Continuous learning
- Career development
- All salaried, full-time candidates are eligible for our generous, flexible vacation policy
- A 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- A variety of leadership and technical development academies to help build your skills and capabilities
- Remote within the United States
Company Overview