Role Description The ERS Mapping Specialist is responsible for configuring, maintaining, and optimizing electronic remittance advice (ERA/835) mapping within the IMAGINE platform to enable accurate and timely automated payment posting. This role ensures payer payment, adjustment, denial, and patient responsibility data are correctly interpreted and translated into system rules that support clean electronic posting, minimize manual intervention, and maximize revenue cycle efficiency. The specialist serves as a subject matter expert for remittance structure, reimbursement methodologies, and mapping accuracy while maintaining documentation and driving continuous improvements to posting performance. Essential Functions and Tasks - Configure and maintain ERA/835 remittance mapping rules to support automated payment posting. - Interpret Explanation of Benefits (EOBs), payer methodologies, and remittance data elements to ensure accurate financial outcomes. - Validate and test mapping logic for payments, contractual adjustments, denials, and patient responsibility. - Edit and update mapping rules as payer formats or reimbursement methodologies change. - Generate correction and exception reports to identify posting issues and root causes. - Investigate and resolve mapping errors impacting revenue or posting accuracy. - Maintain and update ERS Mapping Process Guide and related documentation. - Partner with Posting, Enrollment, and Revenue Cycle teams to ensure alignment on payer requirements. - Support continuous improvement initiatives to increase automation rates and reduce manual posting. - Escalate systemic issues or payer anomalies to leadership with recommended solutions. - Perform other duties as assigned in support of ERA/EDI optimization efforts. Qualifications - Bachelor’s Degree. - 1+ year experience in medical billing or revenue cycle operations required. - Experience with ERA/835 remittance processing or electronic payment posting preferred. - Knowledge of medical terminology and coding concepts required. - Familiarity with third-party payer billing and reimbursement processes required. Requirements - Strong understanding of ERA/835 remittance structures and payment logic. - Ability to interpret EOBs and payer reimbursement methodologies. - High attention to detail and accuracy in rule configuration. - Analytical and problem-solving skills with ability to diagnose posting discrepancies. - Ability to work independently in a fast-paced production environment. - Strong organizational and documentation skills. - Effective written and verbal communication skills. - Proficiency with Microsoft Office Suite and standard RCM systems. Travel - Remote - Not required unless specifically requested in service of a particular client. Compensation - Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. - This position is also eligible for a discretionary incentive bonus in accordance with company policies.

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 We are seeking a talented individual for a DRG Nurse Quality Auditor, Sr. Specialist who is responsible for performing on-going quality assurance audits of the accuracy and consistency of work performed by clinical and coding staff. Responsibilities include performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS code assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have extensive clinical experience and an active coding certification with a background in auditing medical records with a high level of understanding payment methodologies including MS-DRG, and APR-DRG. What you will do - Conducts QA audits to ensure accurate determinations and high-quality documentation. - Identifies quality trends and develops corrective education and training. - Reviews medical records for accurate coding, compliance, and guideline adherence. - Applies job aids, policies, and criteria consistently during reviews. - Documents review decisions clearly for reporting and trending. - Meets productivity and quality standards while completing all review elements accurately. - Supports and trains new reviewers, coders, or clinical DRG auditors as needed. - Demonstrates strong knowledge of payment methodologies, DRG validation, and client-specific requirements. - Maintains current knowledge of coding guidelines, licensure, and CEU requirements. - Participates in trainings, cross-trains on claim types, and supports projects, analysis, and reporting. - Serves as a subject matter expert as needed. What we're looking for - Associates degree required; bachelor’s degree preferred. - Active, unrestricted RN licensure from the United States and in the state of primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required - One of the following Coding Certifications required: RHIA, RHIT, CCS, CIC, CCDS or CPC - 5+ years clinical experience in an inpatient hospital setting required - 3+ 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 but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and 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 - Excellent written communication skills including ability to write clear, concise, accurate, and fact-based rationales in support of review determinations. - Advanced knowledge of medical codes, coding conventions and rules. - Demonstrated experience in medical review, chart audits and quality improvement processes. What you should expect in this role - Remote within the U.S. - 0–10% travel required Applications for this posting will be accepted until April 24, 2026. The pay range for this position is $80,600.00 - $115,200.00 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 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), 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.

• Coding Specialists are an important part of the Team at CorroHealth • The Coding Team Member will provide CPT, HCPCS and ICD-10-CM coding a minimum of 1-4 specialties • Must have 2 years of paid Work experience in Rural Health coding • Provide various components of coding services to support our clients • Rural Health Clinic coding experience required • Calculate ProFee E/M levels by using an algorithm created by our company • Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS • Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program

We have immediate openings for part-time Certified Medical Coder's with strong experience in multi-specialty outpatient facility and verification of professional charges. Ideal candidates will have experience in Orthopedic, Physician Pain Clinic, Endoscopy, and additional surgery specialty coding. A solid understanding of CPT, ICD-10-CM, HCPCS, and surgical documentations is required. Preference will be given to those with significant surgical coding experience. This position is not coding specialty clinic accounts. Purpose The Medical Coding Specialist plays a key part in ensuring accurate coding for optimal reimbursement and compliance with all coding and billing guidelines. Organizational Structure: The Coding Specialist reports to the Senior Coding Manager. Key Responsibilities: - Accurately review and assign CPT, ICD-10-CM, and HCPCS Level II codes to multi-specialty outpatient surgery and inpatient/outpatient pro fee coding. - Ensure that coding is compliant with federal regulations, payer-specific guidelines, and facility coding policies. Meets productivity standards for position. - Abstract relevant clinical information from surgical notes, operative reports, and related medical documentation. - Work collaboratively with physicians, surgical staff, and billing teams to clarify documentation and ensure coding accuracy. - Utilize coding software, encoder tools, and EHR systems effectively to support accurate and timely charge capture. - Continually enhances coding skills by keeping up-to-date with current coding guidelines and changes in regulations, payer policies, and CMS requirements. Participates in team meetings and educational conferences to ensure coding practice remains current. - Maintains confidentiality and safeguards the privacy of protected health information (PHI). - Conduct periodic audits of coded data to ensure accuracy and identify areas for improvement. - Assist in resolving coding-related denials and contribute to appeal processes when necessary. - Performs other job-related duties as may be assigned or required. Education: High school diploma or GED equivalent. Completion of a formal coding program with the following certification required: Certified Professional Coder (CPC), Certified Coding Specialist - Physician based (CCS-P), or equivalent AAPC or AHIMA approved coding credentials. Candidates with apprenticeship designations in their credentials, regardless of years of experience, will not be considered. Experience: Minimum of three years’ coding work experience encompassing a working knowledge of the ICD and CPT coding systems; medical terminology; anatomy and physiology; and health record content. At least 2 years' specifically in ambulatory surgical service and written and verbal communication skills. Preferred experience to those with familiarity with NCCI edits, modifier usage, and payer-specific rules. Knowledge of reimbursement methodologies (e.g., APC's, fee-for-services) Physical Work Environment: The work environment is a home-based position that involves long periods of sitting with repetitive motions of hand and arm and may include frequent bending and twisting.