DRG Coding Audit Manager
Core
Leads a team auditing inpatient medical records to ensure DRG assignment accuracy, identify coding discrepancies, and support regulatory integrity.
Role type
Manager, DRG Coding Audit
Builds
Audit methodologies, program/project scope, metrics, and reporting tools for payer compliance and financial outcomes.
Domain
Healthcare administration / Medical coding (DRG, ICD-10)
Required skills
Project/program management, process reengineering, organizational design, ICD-10 coding expertise, clinical guidelines knowledge, team leadership, financial outcome analysis, variance analysis, documentation development.
Preferred skills
Inpatient coding or DRG auditing experience, MS-DRG and APR-DRG knowledge, medical claims billing/payment systems knowledge, payer reimbursement policies knowledge, billing validation criteria knowledge, coding terminology knowledge.
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 DRG shifts, plans program scope, develops metrics and reporting tools, champions local stakeholders, suggests process improvement recommendations.
Seniority
Manager, hands-on leadership
