Gainwell Technologies · 8 hours ago
Clinical DRG Auditor- Remote
United States
Contract
Remote
Mid Level
$85K/yr - $95K/yr
3+ years expGainwell Technologies is seeking a talented individual for a Clinical DRG Auditor who is responsible for performing DRG validation reviews of medical records. The role involves auditing medical records for accuracy in coding and documentation while adhering to regulatory guidelines.
Health CareInformation Technology
Responsibilities
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 and clinical knowledge to substantiate conclusions
Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale
Applies clinical review judgment to make coding validation determinations including sequencing ICD-10-CM, ICD-10-PCS procedural codes for inpatient claims
Consistently achieves productivity and quality performance standards established by management
Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education
Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain RN license and coding certification
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations
Qualification
Required
Active, unrestricted RN licensure from the United States and in the state of primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required
At least one of the following Coding Certifications is required and is to be maintained as a condition of employment: RHIA, RHIT, CCS, CIC, CCDS or CPC
3+ years clinical experience in an inpatient hospital setting required
2+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
Demonstrated ability to apply clinical review judgment to make clinical determinations
Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc
Benefits
Sign-on bonuses are available for highly qualified candidates
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Variety of leadership and technical development academies to help build your skills and capabilities
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (90)
2024 (78)
2023 (56)
2022 (96)
2021 (33)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-06Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Gary Call
Chief Medical Officer
Recent News
bloomberglaw.com
2025-12-12
GlobeNewswire
2025-12-11
Company data provided by crunchbase