Diagnosis-Related Group Manager

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

📋 Description

• Assist in the execution and continuous enhancement of DRG audit programs, which encompass readmissions and place of service evaluations.

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

• Supervise daily audit operations to align with service level agreements (SLAs), quality standards, and productivity objectives.

• Manage inventory, workflow allocation, aging, and throughput to ensure audits are completed on time.

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

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

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

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

• Identify operational deficiencies and participate in process enhancement initiatives.

• Escalate and assist in resolving client or operational challenges.

• Support the reporting of productivity, quality, and inventory metrics.

• Aid in program implementations and operational initiatives.

⛳️ Requirements

• A Registered Nurse credential is required.

• Certifications such as CCS, CIC, CPC, RHIT, or RHIA are preferred.

• 5 to 8 years of experience with MS-DRG and APR-DRG, demonstrating strong knowledge of ICD-10-CM/PCS and Official Coding Guidelines.

• Previous experience in leadership or supervisory roles is essential.

• A solid understanding of DRG reimbursement methodologies is required.

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

• Experience in audit or payment integrity operations is vital.

• Strong analytical abilities to identify trends and support decision-making processes.

• Excellent communication and interpersonal skills are essential.

• Proficiency in Microsoft Office and audit/reporting systems is required.

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

• In-depth understanding of quality, productivity, and audit accuracy standards is needed.

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

• Effective collaboration across clinical, operational, and technical teams is crucial.

• Capacity to support process enhancements and workflow improvements is necessary.

• Strong organizational and time management skills are essential.

• Ability to cultivate relationships and maintain positive interactions with team members and clients.

• A brief coding/auditing assessment may be part of the interview process.

🏝️ Benefits

• Options for healthcare, vision, dental, and 401(k) plans.

• A dynamic, innovative environment featuring industry-leading professionals.

• Practical experience with high-profile healthcare clients.

• A culture that promotes collaboration, support, and inclusivity.

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