To promote the resource utilization of coal gasification slag and reduce the environmental pollution caused by heavy metals, this study took the gasification coarse slag from a coal chemical enterprise in Inner Mongolia as the research object. The microstructural characteristics, chemical element composition, heavy metal speciation, and risk assessment code (RAC) before and after washing were analyzed in detail. Under simulated acid rain (pH=4.5) and groundwater (pH=7.0) conditions, the leaching behavior of heavy metals in static and dynamic leaching processes was investigated to evaluate the potential environmental impact of using coarse slag as a filling material. The results showed that coal gasification coarse slag mainly consisted of amorphous aluminosilicates, with small amounts of quartz and calcite. After washing, the slag structure became loose, flocculent residual carbon was removed, and the adhesiveness and cohesion of the slag improved. The chemical composition of the washed slag remained dominated by SiO2 and Al2O3, while the contents of CaO, K2O, TiO2 decreased, indicating that the washing process was effective in removing heavy metals. Heavy metals such as Cu, Pb, and Cr in the washed slag mainly existed in stable residual forms, with low proportions of exchangeable and carbonate-bound forms, suggesting low risks of desorption and release under acidic conditions. RAC analysis showed that the RAC values of Cu and Cr in the washed slag ranged from 1 to 10, indicating low risk, while the RAC value of Pb decreased to 30—50, indicating high risk. Static leaching experiments showed that under simulated acid rain conditions, the leaching concentrations of Cu, Pb, and Cr from the washed slag reached 590.4μg/L, 67μg/L, and 76.24μg/L, respectively. Dynamic leaching experiments under the same conditions showed that the leaching concentrations of heavy metals reached 298.6μg/L, 74.7μg/L, and 48.96μg/L, respectively. The leaching concentrations of heavy metals in both experiments were lower than the Class Ⅳ groundwater standards, indicating low environmental risks. It is suggested that the washed slag is suitable for use as a filling material in goaf grouting applications.