EXL

Senior Manager – DRG Concept Development Analyst

EXL

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $100,000 - $125,000 per year

Job Level

Senior

About the role

  • Collaborate with Payment Integrity Audit program leaders, DRG audit professionals and Data & Analytic team members to research, develop and implement inpatient DRG audit selection criteria.
  • Analyze performance metrics and results to ensure alignment with team goals.
  • Subject matter expert for research, analysis and generation of new concepts and selection rules to identify overpayment opportunities in MS DRG & APR-DRG validation.
  • Collaborate with internal stakeholders including the audit and analytic teams to review concepts pre-and post- implementation to monitor concept performance and identify performance issues.
  • Effectively utilize internal selection tools to build queries and concepts and test concept effectiveness.
  • Deliver results and insights to senior leaders.
  • Adjust selection criteria based on specific client requirements.
  • Responsible for monthly claim screening and selection.
  • Verify the selections output to ensure selection rules are functioning as intended.
  • Review appeals/disputes to identify areas for improvement.
  • Create education and training documents and conduct handoff meetings with the Audit teams to ensure understanding of new audit concepts.
  • Ensure the clinical team is calibrated with client policies and internal concepts.
  • Utilize Audit Outcome trend reports to monitor and fine-tune existing queries.

Requirements

  • 10+ years of inpatient coding or auditing experience with a mastery level expertise in both MS DRG and APR-DRG methodology.
  • Experience developing audit selection criteria to identify MS DRG & APR-DRG coding errors and overpayments preferred.
  • Experience working with large data sets.
  • Adept at identifying meaningful patterns, trends and root causes from data.
  • Advanced analytical and problem-solving skills.
  • Industry knowledge specific to MS DRG & APR-DRG reimbursement, provider contracts, payer policies, and audit regulations.
  • Excellent oral and written communication skills.
  • Bachelor’s degree in health information management, Healthcare Informatics or Health Care Administration.
  • Active AHIMA certification - RHIA, RHIT or CCS.
  • Experience with encoder tools (3M, Trubridge).
  • Proficient in Microsoft Excel including advanced functions and pivot tables and Power Point.
  • Experience with AI tools preferred.
Benefits
  • Healthcare
  • Vision
  • Dental
  • 401k options
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
inpatient codingauditingMS DRG methodologyAPR-DRG methodologyaudit selection criteriadata analysisanalytical skillsproblem-solving skillslarge data setsencoder tools
Soft Skills
collaborationcommunication skillstraining and educationperformance monitoringconcept developmentroot cause analysisstakeholder engagementadaptabilityattention to detailinsight delivery
Certifications
AHIMA certificationRHIARHITCCS