[Hiring] DRG Clinical and Coding Educator @Gainwell Technologies LLC

Role Description

Gainwell Technologies is seeking an experienced and innovative DRG Clinical & Coding Educator who is responsible for developing, coordinating, and delivering comprehensive training programs for clinical reviewers, DRG validators, and inpatient/outpatient coding auditors. This role serves as the subject matter expert for DRG validation, APR-DRG, MS-DRG, assignment, ICD-10-CM/PCS coding guidelines, clinical documentation requirements, and payment integrity audit methodologies.

• Develop and deliver training programs for DRG auditors, coders, CDI teams, clinicians, and physicians.
• Create and maintain coding education materials, presentations, webinars, and training content.
• Serve as an ICD-10, DRG validation, and coding guidelines subject matter expert (SME).
• Mentor and coach clinical teams to ensure audit and coding accuracy.
• Analyze quality trends and training needs, and provide targeted education.
• Monitor quality metrics and implement educational improvements.
• Ensure training content complies with coding guidelines, regulations, and clinical policies.
• Maintain documentation of training activities and accreditation requirements.
• Support clinical claim reviews, quality audits, and appeals as needed.
• Maintain expertise in coding, clinical review processes, workflows, and industry standards.

Qualifications

• Education: Associates degree in Health Information Management, Nursing, Clinical Sciences or related healthcare fields required, Bachelor’s Degree preferred.
• License/Certification: Current, active and unencumbered Registered Nurse License, Inpatient Coding Certification (CCS, CIC, CCDS, CDIP, CPMA, RHIA, RHIT).
• Minimum of 5 years experience in inpatient claims auditing, quality assurance, or clinical documentation integrity.
• Minimum of 5 years of experience performing DRG Validation Audits, inpatient coding, with extensive experience in APR DRG as well as MS DRG.
• 3+ years of experience with developing education programs related to healthcare policy, Medicare guidelines and State regulation research and interpretation.
• 5+ years of professional medical coding experience, including experience supporting coding education, training, quality review, and audit activities.
• Experience applying inpatient hospital and outpatient facility coding and billing rules.
• Understanding of clinical claims review audit techniques, identifying overpayments/underpayments, or other identification of revenue opportunities.

Requirements

• Remote within the U.S.
• Full-time position.
• Benefits effective on Day 1.
• Applications accepted through October 30, 2026.
• The pay range for this position is $86,800.00 - $115,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• A variety of leadership and technical development academies to help build your skills and capabilities.