DRG Quality Manager

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

📋 Description

• Assist in the execution and continuous enhancement of DRG quality review initiatives, including assessments of readmissions and places of service.

• Collaborate with technology, operations, and training teams to deploy solutions for audit quality.

• Supervise daily quality review activities in accordance with client SLAs, quality standards, productivity targets, and internal benchmarks.

• Manage the quality review inventory, distribution of workflows, QA aging, and productivity levels.

• Directly oversee DRG quality analysts through coaching, feedback provision, and performance management.

• Ensure compliance with productivity, quality, accuracy, and SLA benchmarks.

• Stay updated on regulatory and payer guideline changes to ensure compliance.

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

• Identify gaps in quality, operations, and processes, driving initiatives for improvement.

• Escalate and assist in resolving issues related to clients, quality, auditor performance, and operations.

• Support the reporting of productivity, quality, audit accuracy, QA inventory, and defect trends.

• Aid in program implementation by establishing quality expectations, review criteria, and quality control procedures.

• Ensure uniformity among quality analysts, programs, operations, training, and global partners.

• Promote ongoing development, deepening knowledge, and skill enhancement of quality analysts.

⛳️ Requirements

• An active coding credential is required, such as CCS, RHIT, RHIA, or CPC.

• 5–8 years of experience with MS-DRG and APR-DRG.

• Strong understanding of ICD-10-CM/PCS and Official Coding Guidelines.

• Previous experience in team leadership or supervisory roles.

• Deep knowledge of DRG reimbursement methodologies.

• Familiarity with Medicare, Medicaid, CMS regulations, and guidelines from commercial payers.

• Background in audit, payment integrity operations, healthcare quality operations, or coding quality review.

• Strong analytical abilities and skill in identifying trends.

• Proficient in Microsoft Office, dashboards, Excel, and audit/reporting systems.

• Knowledge of Lean, Six Sigma, or similar methodologies is preferred.

• Excellent verbal, written, and presentation communication skills.

• Capability to manage multiple priorities and projects under pressure.

• Flexibility to adapt to evolving program, client, and operational demands.

🏝️ Benefits

• Healthcare insurance.

• Vision insurance.

• Dental insurance.

• 401(k) options.

• Work from home / 100% remote opportunities.

• Limited travel required for team meetings.

• Hands-on experience with leading healthcare clients.

• A collaborative, supportive, and inclusive culture.

• A fast-paced, innovative work environment.