Job Description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary:

Gainwell Technologies is seeking an experience and innovative Clinical Education Specialist to lead training and education activities for the Payment Integrity and Utilization Management clinical teams. The Clinical Education Specialist is responsible for the development, initiation, evaluation and oversight of initial and ongoing clinical education and professional development for nurse and coder personnel. A key component of this role is developing and delivering a comprehensive training and mentoring program for clinical staff. This includes developing or enhancing existing clinical and coding new employee education and developing ongoing training for key clinical initiatives.

Your role in our mission:

• Develops a comprehensive training and education program to meet the needs of the nurse, coder, and clinician auditor
• Develops and maintains training materials, presentations, webinars, and content for all payment integrity and utilization management review types or concept.
• Delivers live training and education via multiple modalities to ensure user engagement and understanding.
• Serves as a SME, mentor, educator, coach, innovator to assure the clinical team is proficient in performing the required complex audits such as place of service, level of care, and DRG validation.
• Perform Quality Assurance checks on final review work during and after the orientation period.
• Develops new hire nurse and/or coder job specific training and proficiency program
• Collaborates with the Clinical Innovation Team, Quality Team, and Clinical Service Team to assess, trend and analyze the learning needs of the clinical team and develops appropriate training in response to identified quality trends
• Closely monitors quality metrics to adjust areas of focus and the need for additional education and interventions.
• Develops education content that is aligned and compliant with regulations and clinical policies.
• Maintains documentation of all training activities delivered and to ensure high quality and meet accreditation requirements.
• Work in conjunction with the Medical Director and Innovation teams to develop and document clinical and coding content standards. Identify best practices in the company or industry and use in solution development.
• Develop training and education, and work with clinical teams to make sure that coding content standards are well understood by all levels of the organization.
• Understanding of clinical claims review audit techniques, identifying overpayments/underpayments, or other identification of revenue opportunities
• Experience applying inpatient hospital and outpatient facility coding and billing rules
• Maintain expertise in current Gainwell clinical and coding program processes, workflows and outcomes.
• Perform clinical claim review audits, quality audits, or appeals when no active training classes are progress.
• Extensive experience applying clinical or coding guidelines such as InterQual, MCG, CMS Guidelines, Coding Guidelines and criteria.

What we're looking for:

• Bachelor’s Degree or 10 years of experience in lieu of education
• Current, active and unencumbered Registered Nurse License , Inpatient Coding Certification (CCS, CIC, RHIA, RHIT)
• Minimum of 5 years experience in payment integrity audits and previously healthcare management experience
• 5+ years of experience with developing education programs related to healthcare policy, Medicare guidelines and State regulation research and interpretation.
• 5+ years experience using MCG or InterQual criteria preferred
• 5+ year clinical medical record auditing/validation experience required, preferably in a hospital setting

What you should expect in this role:

• This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (40 hours per week).
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Computer for work company provided.
• For all remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload . Greater speeds will of course provide better performance.
  • To Test your internet download and upload speed:
    • Go to Google.
    • Search for Internet Speed Test .
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

This position is intended for pipelining. We will accept applications on an ongoing basis.

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#LI-REMOTE

The pay range for this position is $75,400.00 - $99,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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