Diagnosis-Related Group Manager

🕒 3 days ago

🇺🇸 United States – Remote

💵 $100k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 4%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• Support the execution and ongoing improvement of DRG audit programs, including readmissions and place of service reviews • Partner with product, analytics, technology, and operations teams to implement audit solutions • Oversee day-to-day audit operations in alignment with SLAs, quality expectations, and productivity goals • Manage inventory, workflow distribution, aging, and throughput to ensure timely audit completion • Directly supervise auditors through coaching, feedback, and performance management • Ensure adherence to productivity, quality, and turnaround standards • Monitor regulatory and payer guideline updates to keep audits compliant and current • Support one-on-ones, training, and development planning • Identify operational gaps and contribute to process improvement initiatives • Escalate and help resolve client or operational issues • Support reporting on productivity, quality, and inventory metrics • Assist with program implementations and operational initiatives

🎯 Requirements

• Registered Nurse required • CCS, CIC, CPC, RHIT, or RHIA preferred • 5–8 years of experience with MS-DRG and APR-DRG, including 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, and commercial payer guidelines • Experience working in audit or payment integrity operations • Strong analytical skills with ability to identify trends and support decision-making • Effective communication and interpersonal skills • Proficiency in Microsoft Office and audit/reporting systems • Ability to manage audit workflows and team performance to meet operational targets • Strong understanding of quality, productivity, and audit accuracy standards • Ability to analyze data and identify trends and improvement opportunities • Effective collaboration across clinical, operational, and technical teams • Ability to support process improvements and workflow enhancements • Strong organizational and time management skills • Ability to build relationships and maintain positive team and client interactions • A brief coding/auditing assessment may be included in the interview process

🏖️ Benefits

• Healthcare, vision, dental, and 401(k) options • Fast-paced, innovative environment with industry-leading experts • Hands-on experience with top-tier healthcare clients • Culture of collaboration, support, and inclusivity • Up to 10% annual travel for team meetings and limited client onsite engagements