Manager, Payer Clinical Services – DRG

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Trend Health Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2018

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

💰 Private Equity Round on 2023-01

Healthcare Insurance • Fintech • Artificial Intelligence

Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

📋 Description

• Oversee clinical/coding DRG audits, including MS-DRG, APR-DRG, readmission, and short-stay reviews, to ensure accuracy and compliance with internal policies and industry-standard guidelines. • Identify gaps and improvement opportunities and provide staff education to enhance audit quality and drive revenue performance. • Apply appropriate industry-standard coding guidelines, payer policies, and medical journal references relevant to audit review. • Maintain strong client relationships through accurate clinical and coding audits, continued understanding of client issues and needs, and compliance with payer policies, procedures, guidelines, and continuum-of-care requirements. • Identify client trends related to coding denials and report findings to the clinical team and clients, ensuring client issues are thoroughly acknowledged. • Oversee current staff and new-hire training related to technology, regulatory changes, and operational processes to support efficiency, client satisfaction, and high-quality results. • Participate in the development of education tools for staff and communicate expectations clearly to each team member. • Ensure clients receive detailed historical and current trend reports and verbally communicate findings to clients, coding teams, and nursing teams as appropriate. • Coach, develop, and mentor clinical staff to achieve quality performance by sharing knowledge and practicing servant leadership principles. • Continue developing personal management skills necessary to lead teams and handle unique operational challenges. • Organize training for new and existing team members to ensure each receives the information and tools needed to be successful. • Independently prepare, deliver, and assign client communications to support audit findings. • Maintain required certifications and continuing education requirements.

🎯 Requirements

• Administration, or a related field; equivalent work experience in a similar position may be considered. • Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Registered Nurse credential preferred. • Active coding certification, such as CCS, CPC, or CIC. • Extensive experience in DRG coding validation and/or auditing. • Experience training others. • Experience leading or managing a team.

🏖️ Benefits

• Health insurance • 401(k) plan with employer match • Paid parental leave • Competitive salaries • Comprehensive compensation package