DRG Coding Audit Manager
About The Position
The DRG Coding Audit Manager leads a team that audits inpatient medical records to ensure accurate and compliant Diagnosis-Related Group (DRG) assignments. The role identifies coding discrepancies and recoverable claim opportunities and supports regulatory integrity for the company and its clients. The manager sets audit methodology and team-development direction, ensures audits meet industry best practices and payer-specific requirements, and collaborates with clinical, compliance, provider engagement, and data analytics teams. The position also plans and oversees program/project scope, design, metrics, reporting, documentation, and performance against plans, while advancing process improvements and using coding expertise, clinical guidelines, and industry knowledge to support audit conclusions. The position follows a hybrid schedule, with associates required to work in the office three days per week. The candidate must reside within a reasonable commuting distance of a designated posting location: Virginia, Indiana, Georgia, Ohio, Maryland, New Jersey, New York, or Texas. Alternate locations may be considered if the candidate lives within commuting distance of an office. Travel to the worksite and other locations is required as necessary.
Requirements
- Bachelor's degree (BA/BS) and at least 5 years of experience in project/program management, process reengineering, organizational design, and/or implementation, or an equivalent combination of education and experience.
- Must reside within reasonable commuting distance of a designated posting location or an eligible office location.
- Experience with ICD-9/10-CM, MS-DRG, and APR-DRG is listed as preferred.
Nice To Haves
- At least 5–7 years of inpatient coding or DRG auditing experience, including 2–3 years in a leadership or supervisory capacity.
- Experience working with ICD-9/10-CM, MS-DRG, and APR-DRG.
- Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology.
Responsibilities
- Set strategic direction for audit methodologies and oversee team development.
- Ensure audits meet industry best practices and payer-specific requirements.
- Collaborate with clinical, compliance, provider engagement, and data analytics teams to align audit insights with program goals.
- Hire, train, coach, counsel, and evaluate the performance of direct reports.
- Analyze audit trends, DRG shifts, and financial outcomes to inform strategy.
- Plan program/project scope and design.
- Develop metrics and program/project reporting tools.
- Analyze variance to program/project plans.
- Lead development of documentation supporting business objectives and consistency.
- Champion local stakeholders and tactical decision-makers.
- Recommend and develop high-quality, high-value concepts and process improvements and efficiency recommendations.
- Use advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
- Travel to the worksite and other locations as necessary.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid Time Off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- 401(k) matching.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
