Diagnosis-Related Group (DRG) Manager

EXL•United States,

2d•$100,000 - $120,000•Remote

About The Position

The DRG Manager leads the planning, coordination, and execution of DRG audit activities, ensuring teams meet client SLAs and operational goals. This role oversees inventory, aging, risks, and day-to-day performance, while collaborating cross-functionally to support program success. The role directly manages a team of auditors responsible for MS-DRG and APR-DRG reviews, ensuring accurate coding and reimbursement outcomes. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in Coding Guidelines, Coding Clinic, and audit tools, and a solid understanding of CMS regulations and payer requirements.

Requirements

CCS, RHIT, RHIA preferred
5–8 years of experience with MS-DRG and APR-DRG, including strong knowledge of ICD-10-CM/PCS and Official Coding Guidelines
Prior experience leading teams or acting in a supervisory capacity
Strong understanding of DRG reimbursement methodologies
Knowledge of Medicare, Medicaid, and commercial payer guidelines
Experience working in audit or payment integrity operations
Strong analytical skills with ability to identify trends and support decision-making
Effective communication and interpersonal skills
Proficiency in Microsoft Office and audit/reporting systems
Ability to manage audit workflows and team performance to meet operational targets
Strong understanding of quality, productivity, and audit accuracy standards
Ability to analyze data and identify trends and improvement opportunities
Effective collaboration across clinical, operational, and technical teams
Ability to support process improvements and workflow enhancements
Strong organizational and time management skills
Ability to build relationships and maintain positive team and client interactions

Responsibilities

Support the execution and ongoing improvement of DRG audit programs, including readmissions and place of service reviews
Partner with cross-functional teams (product, analytics, technology, operations) to support implementation of audit solutions
Oversee day-to-day audit operations, ensuring alignment with SLAs, quality expectations, and productivity goals
Manage inventory, workflow distribution, aging, and throughput to ensure timely completion of audits
Provide direct supervision to auditors, including coaching, feedback, and performance management
Ensure adherence to productivity, quality, and turnaround standards
Monitor regulatory and payer guideline updates, ensuring audits remain compliant and current
Support performance management processes, including one-on-ones, training, and development planning
Identify operational gaps and contribute to process improvement initiatives
Escalate and help resolve client or operational issues as needed
Support reporting activities, including productivity, quality, and inventory metrics
Assist with program implementations and operational initiatives