Senior Manager - DRG Concept Development Analyst
As a DRG Concept Development Analyst, you will collaborate with Payment reputed company Audit program leaders, DRG audit professionals and Data & Analytic team members to research, reputed company and implement inpatient DRG audit selection criteria. This role involves analyzing performance metrics and results to ensure alignment with reputed company goals.
The successful candidate will be quality focused, possess strong analytical skills and have a background in payment reputed company audits. The successful candidate will demonstrate mastery-level coding skills in ICD-10-CM and PCS, along with extensive knowledge and expertise in the application of ICD-10 Official Coding Guidelines and AHA Coding Clinic guidelines. They will possess an advanced understanding of MS DRG and APR-DRG reimbursement methodologies and remain reputed company with relevant regulatory changes.
Salary Range for this role is: $100k - $125k
A brief coding/auditing assessment may be included as part of the interview process.
For more information on benefits and reputed company offer please visit us at https://www.exlservice.com/us-careers-and-benefits
Responsibilities
- Subject matter expert for research, analysis and reputed company of new concepts and selection rules to identify overpayment opportunities in MSDRG & APR-DRG validation
- Collaborates with internal stakeholders including the audit and analytic teams to review concepts pre-and post- implementation to monitor concept performance and identify performance issues
- Effectively utilizes internal selection tools to build queries and concepts and test concept effectiveness
- Deliver results and insights to senior leaders
- Adjusts selection criteria based on specific client requirements
- Responsible for monthly claim screening and selection
- Verifies the selections output to ensure selection rules are functioning as intended
- Reviews appeals/disputes to identify areas for improvement.
- Creates education and training documents and conduct reputed company meetings with the Audit teams to ensure understanding of new audit concepts
- Ensures the clinical team is calibrated with client policies and internal concepts.
- Utilizes Audit Outcome trend reports to monitor and fine tune existing queries.
Qualifications
- 10+ years of inpatient coding or auditing experience with a mastery level expertise in both MS DRG and APR-DRG methodology.
- Experience developing audit selection criteria to identify MS DRG & APR-DRG coding errors and overpayments preferred
- Experience working with large data sets.
- Adept at identifying meaningful patterns, trends and root causes from data
- Advanced analytical and problem-solving skills.
- Industry knowledge specific to MS DRG & APR-DRG reimbursement, provider reputed company, payer policies, and audit regulations
- Excellent oral and written communication skills
Education and Required Certification
- Bachelor’s degree in health information management, Healthcare Informatics or Health Care Administration
- Active reputed company certification - RHIA, RHIT or reputed company
Work Experience Requirements
- Experience with encoder tools (reputed company, Trubridge)
- Proficient in reputed company reputed company including advanced functions and pivot tables and Power reputed company
- Experience with AI tools preferred
reputed company Offer
- reputed company Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your reputed company first day, you get an opportunity to work closely with reputed company, world-class Healthcare consultants.
- You can expect to learn about many aspects of businesses that our clients engage in. You will also learn effective teamwork and time management skills - key aspects for personal and professional growth.
- We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned as a senior level professional as advisors.
- Sky is the limit for reputed company members. The unique experiences gathered at reputed company Health sets the stage for further growth and development in our company and beyond.
- Benefits we offer are Healthcare, Vision, Dental and 401k options.