Associate Manager - DRG

Gainwell Technologies LLC

3d•$85,000 - $102,000•Remote

About The Position

We are seeking a talented individual for an Associate Manager, DRG Clinical Claim Review, who is responsible for supervising the day-to-day prepay, post-pay, and utilization review activities of a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers. Manages the daily operations of the team by leading, assigning work, ensuring productivity and quality metrics are achieved, and analyzing production and workflow/processes to increase efficiency and quality. Consistently demonstrates effective change management by communicating changes timely and effectively; building commitment and overcoming resistance; preparing and supporting those affected by change; monitoring transition and evaluating results.

Requirements

Active, unrestricted RN licensure from the United States and in the state of primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required
At least one of the following active Coding Certifications is required and is to be maintained as a condition of employment: RHIA, RHIT, CCS, CIC, CCDS or CPC
5+ years clinical experience in an inpatient hospital setting required
3+ years of MS DRG/APR DRG coding or auditing experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies required
Working knowledge of the application of current official coding guidelines and coding clinic citations

Nice To Haves

Bachelor’s degree in business, healthcare administration, or related field preferred
2+ year’s management or supervisory experience preferred

Responsibilities

Responsible for oversight and hiring of staff, retaining top talent, performance management, coordinating training and education, and providing leadership and mentorship to staff to build and improve skills to provide best-in-class practices to enhance efficiency, quality, and customer satisfaction.
Monitor aging inventory, workload, assignments, productivity, and quality to ensure service level agreements, contract deliverables, and timelines are met.
Evaluate and analyze productivity, utilization, efficiency, finding rates, savings, appeal overturn rate, and reviews completed by staff to identify opportunities for process improvements.
Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; act as a resource for resolving escalated issues, and coach and mentor staff to develop a high-performing team
Analyze reports and data and identify trends and resources that improve the delivery of clinical review services.
Manage and evaluate individual/team performance and take appropriate action to meet and/or exceed performance standards.