DRG Quality Manager

Emploi pas sur LinkedIn

🕒 il y a 4 jours

🇺🇸 États-Unis – Télétravail

💵 $100 000 - $120 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

👻 Score fantôme 4%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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EXL

Site WebLinkedInTous les Emplois

10 000+ employés

🏥 Santé

🛡️ Assurance

📦 Logistique

💰 €2 000 000 Venture Round en 2015-01

Healthcare • Insurance • Logistics

Choisir un partenaire digital ne concerne pas seulement les capacités — c’est également une question de collaboration et de caractère.

Description

• Support execution and ongoing improvement of DRG quality review programs, including readmissions and place of service reviews • Partner with technology, operations, and training teams to implement audit quality solutions • Oversee day-to-day quality review operations against client SLAs, quality expectations, productivity goals, and internal standards • Manage quality review inventory, workflow distribution, QA aging, and productivity • Directly supervise DRG quality analysts through coaching, feedback, and performance management • Ensure adherence to productivity, quality, accuracy, and SLA standards • Monitor regulatory and payer guideline updates for compliance • Support one-on-ones, training, and development planning • Identify quality, operational, and process gaps and drive improvement initiatives • Escalate and help resolve client, quality, auditor performance, and operational issues • Support reporting on productivity, quality, audit accuracy, QA inventory, and defect trends • Assist with program implementations by defining quality expectations, review criteria, and quality control processes • Ensure consistency across quality analysts, programs, Operations, Training, and global partners • Facilitate ongoing development, knowledge depth, and upskilling of quality analysts

🎯 Exigences

• Active coding credential required, such as CCS, RHIT, RHIA, or CPC • 5–8 years of experience with MS-DRG and APR-DRG • Strong knowledge of ICD-10-CM/PCS and Official Coding Guidelines • Prior experience leading teams or acting in a supervisory capacity • Strong understanding of DRG reimbursement methodologies • Knowledge of Medicare, Medicaid, CMS regulations, and commercial payer guidelines • Experience in audit, payment integrity operations, healthcare quality operations, or coding quality review • Strong analytical skills and ability to identify trends • Proficiency in Microsoft Office, dashboards, Excel, and audit/reporting systems • Knowledge of Lean, Six Sigma, or equivalent preferred • Excellent verbal, written, and presentation communication skills • Ability to manage multiple priorities and projects under pressure • Ability to adapt to changing program, client, and operational needs

🏖️ Avantages

• Healthcare insurance • Vision insurance • Dental insurance • 401(k) options • Work from home / 100% remote • Limited travel for team meetings • Hands-on experience with top-tier healthcare clients • Collaborative, supportive, and inclusive culture • Fast-paced, innovative environment