Remote DRG Auditor: RN-Coding Expert + Sign-On Bonus

Clinical DRG Auditor Perform DRG validation (clinical/coding) reviews of medical records and other documentation to verify conditions documented, ICD-10-CM/PCS code assignments, and accuracy of DRG assignment. The role includes accessing proprietary systems, documenting findings, and providing policy/regulatory support. Sign‑on bonuses are available for highly qualified candidates. Responsibilities Perform audits of medical record documentation to determine accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes, adhering to official coding guidelines, coding clinics, and regulatory mandates. Use HMS proprietary auditing systems to document audit determinations and rationale. Make coding validation determinations, including sequencing ICD‑10‑CM, ICD‑10‑PCS procedural codes for inpatient claims. Consistently achieve productivity and quality performance standards established by management. Assist management with training new coders or clinical DRG auditors, providing daily monitoring, mentoring, feedback, and education. Maintain knowledge of coding guidelines and complete required CEUs to maintain RN license and coding certification. Attend training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. Qualifications Active, unrestricted RN licensure in the United States and state of primary home residency, or active compact multistate unrestricted RN license under the Nurse Licensure Compact. At least one of the following coding certifications: RHIA, RHIT, CCS, CIC, CCDS, or CPC. Minimum 3 years of clinical experience in an inpatient hospital setting. Minimum 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 principal diagnosis selection, complications/comorbidities (CCs), 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. Proficiency in computer skills and typing: Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, and virtual meeting tools such as Microsoft Teams and Zoom. Expectations Remote within the U.S. May be required to work extended hours for special business needs. Travel: 0–10% of the time, depending on business needs. Compensation Pay range: $90,000.00 – $105,000.00 per year; base pay may vary by geographic region, internal equity, and job‑related knowledge, skills, and experience. Benefits All salaried, full‑time candidates are eligible for flexible vacation, a 401(k) employer match, comprehensive health benefits, educational assistance, and access to leadership and technical development academies. Applications accepted until May 29, 2026. Gainwell Technologies is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.” #J-18808-Ljbffr Jobs via Dice