Manager

• 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.

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