[Hiring] DRG Clinical & 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.

The DRG Clinical & Coding Educator provides onboarding and ongoing education to ensure staff maintain a high level of coding accuracy, clinical competency, audit consistency, and compliance with industry standards. This position partners closely with Operations, Quality, and Leadership teams to identify educational needs, address knowledge gaps, and support continuous quality improvement initiatives.

• 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.

Qualifications

• Associate degree in Health Information Management, Nursing, Clinical Sciences, or a related healthcare field required; Bachelor's degree preferred.
• 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.

Requirements

• Location: Remote within the United States
• Travel: Up to 10% travel required
• Employment Type: Full-time

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies to help build skills and capabilities