Associate Manager, Clinical Quality

Gainwell Technologies LLC

22d•$64,800 - $92,600•Remote

About The Position

We are 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. The Associate Manager of Clinical Quality plays an integral role in ensuring the accuracy, integrity, and compliance of clinical and coding review activities. This role is responsible for leading a team of clinical auditors and coding professionals to validate DRG assignments, monitor audit quality, identify trends, and drive improvement initiatives that support accurate reimbursement, regulatory compliance, and data integrity. The Associate Manager also oversees and manages the daily operations of the team by leading and assigning work, ensuring productivity and quality metrics are achieved, and analyzing production and workflow processes to increase efficiency and quality. This individual consistently demonstrates effective change management by communicating changes timely and effectively; building commitment and overcoming resistance; supporting those affected by change; and monitoring transitions and evaluating results.

Requirements

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.

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.