Manager of DRG Coding & Clinical Validation Audit

About This Role

Lead a high-performing team responsible for auditing inpatient medical records to ensure the accuracy and compliance of Diagnosis-Related Group (DRG) assignments, identifying coding discrepancies and supporting regulatory integrity.

Responsibilities

• Sets the strategic direction for audit methodologies
• Oversees team development and ensures audits meet industry best practices and payer-specific requirements
• Collaborates cross-functionally with clinical, compliance, provider engagement, and data analytics teams
• Hires, trains, coaches, counsels, and evaluates performance of direct reports
• Analyzes audit trends, DRG shifts, and uses financial outcomes to inform strategy
• Plans program/project scope and design
• Develops metrics and program/project reporting tools
• Analyzes variance to program/project plan
• Leads building of documentation to support business objectives and ensure consistency
• Suggests and develops high quality, high value concept and/or process improvement and efficiency recommendations
• Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions

Requirements

• Minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation or equivalent

Qualifications

• BA/BS
• Minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation, or equivalent; 5-7 years of inpatient coding or DRG auditing experience including 2-3 years in a leadership or supervisory capacity preferred

Nice to Have

• 5-7 years of inpatient coding or DRG auditing experience, including 2-3 years in a leadership or supervisory capacity
• Experience working with ICD-9/10CM, MS-DRG and APR-DRG
• Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology

Skills

* Required skills

Benefits