Gainwell Technologies · 3 weeks ago
Associate Manager, Clinical Quality
United States
Full-time
Remote
Mid, Senior Level
$65K/yr - $93K/yr
5+ years expGainwell Technologies is seeking a talented individual for an Associate Manager, Clinical Quality position who will be responsible for supervising Quality Assurance activities for Coding and DRG Validation reviews. This role involves leading a team of clinical auditors and coding professionals to ensure compliance, accuracy, and improvement in healthcare coding practices.
Health CareInformation Technology
Responsibilities
Supervise the quality review program, creating policies and processes relating to quality and ensuring continuous conformance with appropriate standards, regulations, and contractual agreements
Develop, implement, and maintain quality assurance processes and performance benchmarks for DRG validation, inpatient coding, and outpatient coding/billing audits
Supervise and mentor clinical auditors and coding specialists; provide education, coaching, and performance feedback
Monitor and report key performance indicators (KPIs) for audit accuracy, productivity, and interrater reliability
Identify trends, root causes, and opportunities for improvement in documentation or coding accuracy
Analyze audit results, denial trends, and payer findings to identify systemic issues and recommend corrective actions
Prepare and present regular reports and dashboards for leadership, highlighting performance metrics, audit outcomes, and improvement initiatives
Support compliance and revenue integrity efforts by ensuring the accuracy of coded data used for reimbursement, quality reporting, and analytics
Develop and deliver training programs for coding, clinical, and quality assurance teams
Stay current with evolving CMS regulations, ICD-10-CM/PCS updates, and industry standards for inpatient coding and DRG assignment
Drive continuous quality improvement initiatives to enhance effectiveness and efficiency
Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; act as a resource for resolving escalated issues, and coach and mentor staff to develop a high-performing team
Manage and evaluate individual and team performance, and take appropriate action to meet and/or exceed performance standards
Perform other functions as assigned
Qualification
Required
Associate degree required; bachelor's degree preferred
Unrestricted RN license and one of the following preferred: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), RHIT, RHIA, or Certified Professional Medical Auditor (CPMA)
Working knowledge of the application of current official coding guidelines and Coding Clinic citations
Demonstrates a thorough understanding of APR-DRG, MS-DRG, ICD-10, clinical criteria, and clinical review judgment
Minimum of 5 years of experience in inpatient/outpatient coding, clinical documentation improvement, or DRG validation auditing
Minimum of 2 years of leadership or quality assurance experience in a healthcare or health information management setting
Benefits
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
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