Lead Associate, Outpatient Coding Quality Auditor

Gainwell Technologies

. Conduct detailed reviews of medical records, claims, and supporting documentation to determine the accuracy and appropriateness of assigned ICD-10-CM, CPT, HCPCS Level II, and modifiers .

Posted 9/15/2026full-timeRemote • Texas • United StatesSenior💰 $60,100 - $85,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in outpatient coding, reimbursement methodologies, and compliance with regulatory requirements, while effectively conducting audits and quality assurance processes. Proficient in applying coding guidelines and methodologies to ensure accuracy and appropriateness in medical record coding.

Highest-signal resume keywords

ICD-10-CM CodingCPT CodingHCPCS Level II CodingOutpatient Reimbursement MethodologiesCoding Auditing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Record ReviewCoding Discrepancy IdentificationBilling Error AnalysisCompliance EvaluationAudit DocumentationQuality Assurance AuditsCoding Guidelines InterpretationPayment Methodologies ApplicationPerformance AssessmentProcess Improvement

Soft Skills

Attention to DetailAnalytical ThinkingCommunication SkillsProblem-SolvingTeam Collaboration

Tools & Technologies

Audit Management SystemsCase Management Systems

Certifications & Qualifications

CPCCOCCCSRHIARHIT

Industry Keywords

Outpatient CodingPayment IntegrityCompliance StandardsCMS RegulationsNCCI EditsOPPS RequirementsEAPG MethodologiesAPC Payment PoliciesASC Reimbursement GuidelinesQuality Monitoring Processes

About the role

Key responsibilities & impact

Conduct detailed reviews of medical records, claims, and supporting documentation to determine the accuracy and appropriateness of assigned ICD-10-CM, CPT, HCPCS Level II, and modifiers
Apply contract-specific review methodologies to identify coding discrepancies, billing errors, reimbursement inaccuracies, and compliance concerns
Evaluate documentation to ensure coding assignments are supported and compliant with applicable regulatory and payer requirements
Accurately document audit findings, rationale, and recommendations using proprietary audit and case management systems
Provide comprehensive coding and reimbursement determinations supported by clinical documentation, coding guidelines, payment methodologies, and regulatory requirements
Perform ongoing quality assurance audits of coding and clinical review staff
Interpret and apply official coding guidelines, CMS regulations, NCCI edits, OPPS requirements, EAPG methodologies, APC payment policies, and ASC reimbursement guidelines
Assess auditor and reviewer performance against quality benchmarks and productivity standards
Identify process improvement opportunities and recommend corrective actions
Participate in inter-rater reliability activities and quality calibration sessions
Assist in developing quality monitoring processes, audit tools, and review protocols
Serve as a subject matter expert on outpatient coding, reimbursement methodologies, and payment integrity principles
Achieve productivity and quality performance standards established by management

Requirements

What you’ll need

One or more active professional credentials through AHIMA or AAPC: CPC, COC, CCS, RHIA, RHIT; required
3+ years experience in outpatient medical record coding required
3+ years of coding auditing, quality assurance, or coding validation experience required
Extensive experience reviewing outpatient facility claims and medical records
Demonstrated expertise in outpatient reimbursement methodologies, including Enhanced Ambulatory Patient Groups (EAPG), Ambulatory Payment Classifications (APC), and Ambulatory Surgery Center (ASC) payment systems
Experience performing payment integrity, compliance, or reimbursement-focused audits preferred
Experience leading quality initiatives, training staff, or serving as a coding subject matter expert preferred
Remote position within the United States

Benefits

Comp & perks

Benefits available starting on the first day of employment
Clear career advancement opportunities through training and leadership development
Flexible work hours
Work flexibility, learning, and career development
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies