DRG Quality Manager

🔥 30 minutes ago

🇺🇸 United States – Remote

💵 $100k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 2%

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 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 in alignment with client SLAs, quality expectations, productivity goals, and internal standards • Manage quality review inventory, workflow distribution, QA aging, and productivity • Directly supervise DRG quality analysts and, as needed, analysts supporting other clinical or coding quality specialties • Provide coaching, feedback, performance management, one-on-ones, training, and development planning • Ensure adherence to productivity, quality, accuracy, and SLA standards • Monitor regulatory and payer guideline updates to keep reviews compliant and current • 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 and alignment across quality analysts, programs, Operations, Training, and global partners • Facilitate ongoing development, knowledge depth, and upskilling of quality analysts

🎯 Requirements

• 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 with ability to identify trends and support decision-making • Effective communication and interpersonal skills • Proficiency in Microsoft Office, dashboards, Excel, and audit/reporting systems • Knowledge of process improvement methodologies, including Lean, Six Sigma, or equivalent, preferred • A brief coding/auditing assessment may be included as part of the interview process

🏖️ Benefits

• Competitive benefits package, including healthcare, vision, dental, and 401(k) options • Fast-paced, innovative environment with a team of industry-leading experts • Hands-on experience with top-tier clients in the healthcare industry • Strong culture of collaboration, support, and inclusivity • Limited travel may be required for team meetings