DRG Quality Manager

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

📋 Description

• Assist in the implementation and continuous enhancement of DRG quality review initiatives, encompassing readmission and place of service assessments.

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

• Manage daily quality review operations in accordance with client SLAs, quality standards, productivity objectives, and internal benchmarks.

• Oversee quality review inventory, workflow allocation, QA aging, and productivity metrics.

• Directly supervise DRG quality analysts and, when necessary, analysts focused on other clinical or coding quality areas.

• Offer coaching, constructive feedback, performance management, one-on-one sessions, training, and development planning.

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

• Track updates to regulatory and payer guidelines to ensure reviews remain compliant and up-to-date.

• Identify operational, quality, and process gaps and spearhead improvement initiatives.

• Raise and assist in resolving client, quality, auditor performance, and operational challenges.

• Aid in reporting productivity, quality, audit accuracy, QA inventory, and defect trends.

• Support program implementations by establishing quality expectations, review criteria, and quality control protocols.

• Ensure consistency and alignment among quality analysts, programs, Operations, Training, and global partners.

• Promote ongoing development, depth of knowledge, and skills enhancement for quality analysts.

⛳️ Requirements

• Active coding credential 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 leading teams or fulfilling a supervisory role.

• In-depth knowledge of DRG reimbursement methodologies.

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

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

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

• Effective communication and interpersonal skills.

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

• Knowledge of process improvement methodologies, including Lean, Six Sigma, or equivalent, is preferred.

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

🏝️ Benefits

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

• Fast-paced, innovative environment with a team of industry-leading experts.

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

• Strong culture of collaboration, support, and inclusivity.

• Limited travel may be necessary for team meetings.