Senior Manager – APR DRG Concept Development Analyst

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $100k - $125k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 1%

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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

• Research, analyze and generate new concepts and selection rules to identify overpayment opportunities in APR-DRG validation • Collaborate with audit and analytic teams to review concepts before and after implementation • Monitor concept performance and identify performance issues • Use internal selection tools to build queries and concepts and test concept effectiveness • Deliver results and insights to senior leaders • Adjust selection criteria based on specific client requirements • Perform monthly claim screening and selection • Verify selection outputs to ensure selection rules function as intended • Review appeals and disputes to identify areas for improvement • Create education and training documents and conduct handoff meetings with audit teams • Ensure the clinical team is calibrated with client policies and internal concepts • Use Audit Outcome trend reports to monitor and fine-tune existing queries

🎯 Requirements

• 10+ years of inpatient coding or auditing experience with mastery-level expertise in APR-DRG methodology • Experience developing audit selection criteria to identify APR-DRG coding errors and overpayments preferred • Experience working with large data sets • Ability to identify meaningful patterns, trends and root causes from data • Advanced analytical and problem-solving skills • Industry knowledge specific to APR-DRG reimbursement, provider contracts, payer policies, and audit regulations • Excellent oral and written communication skills • Bachelor’s degree in health information management, Healthcare Informatics or Health Care Administration • Active AHIMA certification: RHIA, RHIT or CCS • Experience with encoder tools (3M, Trubridge) • Proficiency in Microsoft Excel, including advanced functions and pivot tables, and PowerPoint • Experience with AI tools preferred • Mastery-level coding skills in ICD-10-CM and PCS • Extensive knowledge of ICD-10 Official Coding Guidelines and AHA Coding Clinic guidelines • Advanced understanding of MS DRG and APR-DRG reimbursement methodologies • Current knowledge of relevant regulatory changes • A brief coding/auditing assessment may be included in the interview process

🏖️ Benefits

• Healthcare, Vision, Dental and 401k options • Mentoring program with guidance/coaching from senior-level professionals • Opportunities to work with experienced, world-class healthcare consultants • Professional and personal growth and development opportunities • 100% remote work from home