Manager, DRG Review (REMOTE)

Enablecomp-posted 3 months ago
Full-time • Manager
Remote • Franklin, TN
Professional, Scientific, and Technical Services
Resume
Match Score
Upload and Match ResumeTrack Jobs with Teal

The Manager, DRG Review leads a team of DRG Reviewers while continuing to perform hands-on inpatient claim reviews to identify and validate missed reimbursement opportunities. This role oversees daily workflow, provides training and guidance on coding accuracy, and ensures departmental quality and productivity standards are met. Leveraging deep expertise in ICD-10 coding and DRG reimbursement methodology, the Manager partners closely with leadership to optimize hospital reimbursement, drive revenue opportunities, and support client success. This position requires a Certified Coding Specialist (CCS) credential and proven experience in DRG validation, as well as the ability to balance leadership responsibilities with ongoing case review work. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

  • Supervise and mentor a team of DRG Reviewers, providing guidance on coding best practices, case prioritization, and workflow management.
  • Review inpatient claims imported into the DRG database to validate coding accuracy and reimbursement opportunities.
  • Ensure department productivity and quality standards are achieved through monitoring, coaching, and performance evaluations.
  • Collaborate with leadership to allocate resources, manage workloads, and set team priorities.
  • Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.
  • Provide ongoing education on ICD-10 updates, payer guidelines, and DRG reimbursement changes.
  • Analyze reports to identify trends, revenue opportunities, and areas for process improvement.
  • Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.
  • Identify and correct errors such as under coded or misclassified diagnoses and procedures.
  • Make reimbursement improvement recommendations and submit findings for client review and approval.
  • Partner with internal stakeholders to ensure accurate reporting and timely delivery of client findings.
  • Serve as an escalation point for complex coding or reimbursement issues.
  • Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.
  • Identify new revenue opportunities related to all inpatient DRG related components.
  • Other duties as required
  • Associate or bachelor's degree in health information management or related field required. RHIT or RHIA credentialed individuals preferred.
  • Certified Coding Specialist (CCS) certification required.
  • 4-6 years' experience in DRG validation, inpatient medical coding, or related coding review, with at least 1-2 years in a leadership or supervisory role.
  • Strong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes.
  • Proven ability to lead, coach, and develop a high-performing team while balancing individual workload.
  • Proficient in EMRs, DRG grouping software, billing databases, and MS Office applications.
  • Strong analytical skills with a focus on financial impact, reimbursement accuracy, and process improvement.
Track Jobs with Teal

Job Search Resources

•
Resume Builder
•
Resume Examples
•
Cover Letter Examples

Tools

Career Hubs

Guides

Company

© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service