Director, Pre-Bill DRG Review – Quality Assurance, Training & Education

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🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

🔧 QA Engineer (Quality Assurance)

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Lead the organization's internal pre-bill DRG validation program, ensuring coding accuracy, DRG integrity, and compliance • Design, implement, and continuously improve the quality assurance framework for pre-bill coding review • Build and lead training and education infrastructure for coding staff, CDI specialists, and auditors • Partner with HIM leadership, CDI, Compliance, Revenue Cycle, and Physician Advisors to reduce DRG mismatches and denials • Establish and maintain a QA framework for coding and DRG validation • Set and monitor performance benchmarks and report trends to senior leadership • Manage a team of DRG validators, quality auditors, and/or training specialists

🎯 Requirements

• Bachelor's degree in Health Information Management, Nursing, Health Administration, or related field required • Master's degree preferred • Certification RHIA, RHIT, CCS, or CDIP required (one or more) • CCDS or CCS-P a plus • Active, unencumbered credential required; must be maintained throughout employment • 7+ years of progressive experience in inpatient coding, DRG validation, clinical documentation integrity, or coding quality/compliance auditing • 3+ years of leadership or management experience, including oversight of quality assurance and/or training functions • Demonstrated expertise in MS-DRG and APR-DRG methodology, ICD-10-CM/PCS coding, and CMS regulatory requirements • Experience designing and delivering adult education/training programs in a healthcare coding or clinical setting • Prior experience with pre-bill review, second-level review, or denials/appeals management strongly preferred

🏖️ Benefits

• Competitive salary commensurate to related experience • Quality of life with a remote predictable, full-time schedule • Medical, Dental, Vision coverage + more • 401K with company match • Long-term disability insurance, and life insurance • Ample parental leave • Certification and Tuition Reimbursement • Holidays and Flexible paid time off