Supervisor of Coding Operations
Datavant
Manager, DRG Review
EnableComp
full-time
Posted on:
Location: Tennessee • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- 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.
Requirements
- 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.
- Ability to handle patient health information (PHI) with high integrity, privacy, and security.
- Excellent communication and documentation skills.
- Ability to review and analyze large volumes of medical and billing data and manage high volumes of case processing.
