• Drive internal audit initiatives, special projects, and improvement initiatives in accordance with the Institute of Internal Auditors (IIA) Global Internal Audit Standards, including requirements for planning, performing, and communicating results • Develop and apply audit criteria and performance measures for assigned engagements • Apply IIA-aligned audit methodology when evaluating the adequacy, effectiveness, and efficiency of internal controls and ongoing operations • Provide task assignments, guidance, and initial workpaper review for Internal Auditor I staff • Perform detailed reviews of workpapers to ensure IIA expectations for evidence quality, analysis, and documentation are met • Conduct periodic audit follow-ups to assess and report on progress or completion of management’s corrective actions • Conduct other audit and compliance activities, such as internal investigations, as assigned • Prepare audit and advisory reports for Director of Internal Audit review • Apply the IIA’s guidance on risk assessment and prioritization when developing engagement-level audit objectives and testing strategies • Design audit programs and testing procedures consistent with IIA guidance on planning and due professional care • Maintain and refine internal audit methodology, including policies, procedures, templates, and tools • Align audit activities with internal audit strategy, goals, and objectives • Assist in defining and managing content for the internal audit manual • Contribute to the development of the internal audit training program; work with supervisor to establish training goals • Participate in organizational risk management activities, including contributing to the annual risk assessment that informs the audit plan • Assist in the annual system-wide Enterprise Risk Management risk assessment cycle • Support protocols to promote consistent use of IIA audit methodology • Provide input on staff development needs and support skill‑building activities • Support consistent application of IIA Standards by answering questions and helping staff resolve methodological issues • Assist with occasional knowledge sharing or focused training, as needed, to strengthen team capability • Provide mentoring and coaching to internal auditor staff and compliance auditors (analysts) • Effectively communicate with internal audit staff, Director of Internal audit, and Alliance management • Build relationships with key constituents and serve as a resource of professional audit advice, as appropriate • Build and nurture key management and business relationships • Manage external relationships, i.e. with external auditors, regulators and consultants • Document audit results accurately and completely using the designated internal audit software • Communicate the results of audit activities via written reports and oral presentations to appropriate management and other stakeholders

• Analyze client invoice data and pinpoint vendor overbillings or under billings. • Apply general audit principles such as pattern recognition, data filtering, and cross-referencing multiple data sources. • Analyze contracts, tariffs, Interconnection Agreements, and research potential data sources. • Use software such as MS Excel, SQL, MS Access, Python, KNIME, Alteryx, and Business Objects. • Load potential overbillings or underbillings into TEOCO's web-based Claim Center application. • Provide ongoing support to the reconciliation team and participate in client calls as needed.

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 $85,000.00 - $102,000.00 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.

• The Attorney Auditor reviews legal and non-legal invoices on behalf of our clients for services provided to insurance carriers, corporate legal departments and government entities. • The auditor will apply client specified billing guidelines and/or Generally Accepted Principles and Standards (“GAPS”).