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 strategy and methodologies, oversees team development, and ensures audits follow industry best practices and payer-specific requirements. The position collaborates with clinical, compliance, provider engagement, and data analytics teams to align audit findings with broader program goals. The role also plans program and project scope and design, develops metrics and reporting tools, analyzes performance against plans, builds supporting documentation, champions local stakeholders and decision-makers, and recommends process improvements and efficiencies. The selected candidate must live within reasonable commuting distance of designated posting locations or an eligible alternate office. The position is hybrid, requiring in-office work three days per week, and travel to worksites and other locations as necessary. Salary range for specified locations is $115,020 to $207,216.
Requirements
- Bachelor's degree (BA/BS) and at least 5 years of experience in project/program management, process reengineering, organizational design, and/or implementation; an equivalent combination of education and experience is acceptable.
- Must reside within reasonable commuting distance of the designated posting locations or a considered alternate office, unless an accommodation is granted as required by law.
- Ability to travel to worksites and other locations as necessary.
Nice To Haves
- At least 5–7 years of inpatient coding or DRG auditing experience.
- 2–3 years of leadership or supervisory experience.
- Experience with ICD-9/10-CM, MS-DRG, and APR-DRG.
- Broad knowledge of medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology.
Responsibilities
- Set strategic direction for audit methodologies and ensure audits meet industry best practices and payer-specific requirements.
- Oversee team development and hire, train, coach, counsel, and evaluate direct reports.
- Collaborate with clinical, compliance, provider engagement, and data analytics teams to align audit insights with program goals.
- Analyze audit trends, DRG shifts, and financial outcomes to inform strategy.
- Plan program and project scope and design.
- Develop program and project metrics and reporting tools.
- Analyze variances against program and project plans.
- Lead development of documentation supporting business objectives and consistency.
- Champion local stakeholders and tactical decision-makers.
- Recommend high-quality, high-value concepts and process improvements and efficiencies.
- Use advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
- Travel to worksites and other locations as necessary.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution and matching.
- 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.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
