Manager of DRG Coding & Clinical Validation Audit
Core
Leads a high-performing team auditing inpatient medical records to ensure the accuracy and compliance of Diagnosis-Related Group (DRG) assignments, identifying coding discrepancies and recoverable claim opportunities.
Role type
Manager of DRG Coding & Clinical Validation Audit
Builds
Audit methodologies, team capabilities, and program/project scope for medical claims billing/payment systems
Domain
Healthcare administration, medical coding, and payer reimbursement
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Project/program management, process reengineering, organizational design, ICD-10 coding expertise, clinical guidelines knowledge, team leadership, strategic direction setting, cross-functional collaboration, performance evaluation, trend analysis, financial outcome analysis, documentation development, stakeholder management, process improvement
Preferred skills
Inpatient coding or DRG auditing experience, MS-DRG and APR-DRG knowledge, medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria, coding terminology
Technologies
ICD-9, ICD-10CM, MS-DRG, APR-DRG
Responsibilities
Sets strategic direction for audit methodologies, oversees team development, collaborates cross-functionally with clinical and compliance teams, hires and evaluates direct reports, analyzes audit trends and financial outcomes, plans program scope, develops metrics and reporting tools, leads documentation building, champions local stakeholders, suggests process improvement recommendations
Seniority
Manager, hands-on leadership