DRG Manager

Job Summary

To support the Complex Payment Solutions Team, the remote DRG Manager will manage clinical solutions development, oversee claims review processes, and lead a team, leveraging expertise in healthcare payment methodologies and auditing.

Key responsibilities

• Enhance and review clinical solutions related to readmissions and place of service
• Collaborate with cross-functional teams to implement DRG process ideas
• Lead the DRG team, providing guidance and development plans for staff retention and growth

Required qualifications

• Bachelor's degree in health administration, business, or nursing
• 5+ years of experience in healthcare billing and coding
• 3+ years of experience in claims auditing and recovery auditing
• Proven knowledge of classification systems, including MSDRG and APR DRG
• Expertise in DRG validation and familiarity with Milliman and InterQual guidelines