Director of Pre-Bill DRG Review

Job Summary

Leading the internal pre-bill DRG validation program, the full-time Director of Pre-Bill DRG Review will ensure coding accuracy and compliance prior to claim submission while designing and implementing a quality assurance framework and a training infrastructure for coding staff, all in a remote work environment.

Key Responsibilities

• Own and evolve the pre-bill DRG review program, ensuring alignment with official coding guidelines and performance benchmarks
• Design and implement a structured training program for coders and auditors, developing ongoing education modules based on QA findings
• Collaborate with cross-functional teams to minimize billing delays and resolve clinical documentation ambiguities affecting DRG assignments

Required Qualifications

• Bachelor's degree in Health Information Management, Nursing, Health Administration, or related field required; Master's degree preferred
• RHIA, RHIT, CCS, or CDIP certification required; CCDS or CCS-P is a plus
• 7+ years of experience in inpatient coding, DRG validation, or coding quality auditing, with 3+ years in a leadership role
• Expertise in MS-DRG and APR-DRG methodology, ICD-10-CM/PCS coding, and CMS regulations
• Experience designing and delivering adult education/training programs in a healthcare setting