Diagnosis-Related Group Manager

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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 against SLAs, quality expectations, and productivity goals • Manage inventory, workflow distribution, aging, and throughput for 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 improvements • Escalate and help resolve client or operational issues • Support reporting on productivity, quality, and inventory metrics • Assist with program implementations and operational initiatives

🎯 Requirements

• Bachelor's Degree • 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 • 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 • CCS, RHIT, or RHIA preferred • A brief coding/auditing assessment may be included as part of the interview process

🏖️ Benefits

• Up to 10% annual travel for team meetings and limited client onsite engagements • Competitive benefits package, including healthcare, vision, dental, and 401(k) options • A fast-paced, innovative environment with a team of industry-leading experts • Hands-on experience with top-tier clients in the healthcare industry • A strong culture of collaboration, support, and inclusivity