Manager, Payer Clinical Services – DRG

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

📋 Description

• Manage clinical and coding DRG audits, including MS-DRG, APR-DRG, readmission, and short-stay evaluations, ensuring precision and adherence to internal policies and industry standards.

• Recognize areas for improvement and offer educational support to staff to enhance the quality of audits and boost revenue performance.

• Utilize relevant industry-standard coding guidelines, payer policies, and medical journal references pertinent to audit assessments.

• Build and maintain strong client relationships through precise clinical and coding audits, a deep understanding of client needs, and compliance with payer policies, procedures, guidelines, and continuum-of-care requirements.

• Identify trends in coding denials for clients and relay findings to the clinical team and clients, ensuring all client concerns are fully addressed.

• Supervise training for current staff and new hires regarding technology, regulatory changes, and operational procedures to enhance efficiency, client satisfaction, and quality results.

• Contribute to the creation of educational tools for staff and clearly communicate expectations to each team member.

• Ensure clients receive comprehensive historical and current trend reports and verbally convey findings to clients, coding teams, and nursing teams as necessary.

• Guide, develop, and mentor clinical staff to reach quality performance standards by sharing expertise and adhering to servant leadership principles.

• Continue to enhance personal management skills essential for leading teams and addressing unique operational challenges.

• Organize training sessions for new and existing team members to equip them with the necessary information and tools for success.

• Independently prepare, deliver, and assign client communications to support audit outcomes.

• Maintain required certifications and fulfill continuing education obligations.

⛳️ Requirements

• A degree in Administration or a related field; relevant work experience in a similar role may be accepted in lieu of a degree.

• Preferred credentials include Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Registered Nurse.

• An active coding certification, such as CCS, CPC, or CIC, is required.

• Significant experience in DRG coding validation and/or auditing is essential.

• Experience in training others is necessary.

• Proven experience in leading or managing a team is required.

🏝️ Benefits

• Health insurance

• 401(k) plan with employer match

• Paid parental leave

• Competitive salaries

• Comprehensive compensation package