State Licensed DRG QA Manager

Job Summary

Leading the quality assurance and training team remotely, the State Licensed DRG QA Manager will manage the DRG QA/Trainer staff, oversee the audit program for DRG Reviewers, and direct training initiatives to ensure compliance with clinical and coding standards.

Key responsibilities

• Lead and develop the DRG QA/Trainer team, setting goals and monitoring performance to ensure timely completion of audits and training
• Own the QA audit program, ensuring accuracy and compliance with coding and clinical validation guidelines while providing constructive feedback to DRG Reviewers
• Collaborate with cross-functional teams to develop and maintain training materials, evaluate training effectiveness, and implement continuous improvement initiatives

Required qualifications

• Bachelor's degree in nursing, health information management, or health administration; active nursing license preferred
• 5+ years of experience in healthcare billing and coding, with 3+ years in inpatient claims auditing or Clinical Documentation Integrity
• Previous supervisory experience and experience conducting training for clinical or coding staff
• Certification in one of the following: RHIA, RHIT, CCDS, CDIP, CCS, or CIC
• Expertise in DRG methodologies, ICD-10-CM/PCS coding, and familiarity with Medicare and Commercial coding rules