Diagnosis-Related Group Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Spearhead the planning, coordination, and execution of DRG audit activities.

• Assist in the execution and continuous enhancement of DRG audit programs, including reviews of readmissions and places of service.

• Collaborate with product, analytics, technology, and operations teams to implement audit solutions.

• Supervise daily audit operations to align with SLAs, quality expectations, and productivity targets.

• Manage inventory, workflow distribution, aging, and throughput to ensure timely completion of audits.

• Directly oversee auditors by providing coaching, feedback, and performance management.

• Ensure compliance with productivity, quality, and turnaround standards.

• Keep audits compliant and up-to-date by monitoring changes in regulatory and payer guidelines.

• Facilitate one-on-ones, training sessions, and development planning.

• Identify operational shortcomings and participate in process improvement initiatives.

• Address and help resolve client or operational challenges as they arise.

• Assist in reporting productivity, quality, and inventory metrics.

• Support the implementation of programs and operational initiatives.

• Oversee team performance, risks, client SLAs, and operational objectives.

⛳️ Requirements

• Bachelor's Degree required.

• CCS, RHIT, or RHIA certification preferred.

• 5–8 years of experience with MS-DRG and APR-DRG, including a solid grasp of ICD-10-CM/PCS and Official Coding Guidelines.

• Previous experience leading teams or holding a supervisory role.

• Strong comprehension of DRG reimbursement methodologies.

• Familiarity with Medicare, Medicaid, and commercial payer guidelines.

• Experience in audit or payment integrity operations.

• Excellent analytical skills with the ability to identify trends and facilitate decision-making.

• Strong verbal and written communication skills, along with effective interpersonal abilities.

• Proficient in Microsoft Office and audit/reporting systems.

• Capability to manage audit workflows and team performance to achieve operational goals.

• Deep understanding of quality, productivity, and audit accuracy standards.

• Ability to analyze data and pinpoint trends and opportunities for improvement.

• Effective collaboration skills across clinical, operational, and technical teams.

• Ability to drive process improvements and enhance workflows.

• Strong organizational and time management skills.

• Aptitude for building relationships and fostering positive interactions with team members and clients.

• Must be located in the U.S.

🏝️ Benefits

• Competitive benefits package that includes healthcare, vision, dental, and 401(k) options.

• A dynamic, innovative environment featuring a team of industry-leading experts.

• Hands-on experience with prestigious clients in the healthcare sector.

• A strong culture of collaboration, support, and inclusivity.

• Up to 10% annual travel for team meetings and limited client onsite engagements.