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Apixio · 1 day ago

Assistant Manager, DRG Review

United States

Full-time

Remote

Mid, Senior Level

$105K/yr - $110K/yr

5+ years exp

Apixio is a leading healthcare intelligence company focused on delivering value and efficiency to health plan clients. The Assistant Manager is responsible for leading a team to ensure high-quality DRG validation outcomes while providing mentorship and support to team members.

AnalyticsArtificial Intelligence (AI)Health CareInformation Technology

Responsibilities

Exhibit leadership skills in helping CVS’s to become strong and confident individual and team members

Monitors performance and mentors CVS’s in their team to achieve excellent quality of work and high production. Each team member must continually meet minimal expectations

Assist each team member to maintain and improve their quality of work

Monitors work queues to assure priority cases are reviewed on time

Performs secondary quality reviews looking for missed opportunities

Assists the CVS’s by reviewing and responding to questions submitted by the CVS team

Provides individual CVS education and training with the goal of increasing CVS knowledge

Assures appeals are responded to no later than 30 days after receipt. Analyze appeals looking for team member trends

Maintains awareness of and ensures compliance with coding guidelines and conventions, state and federal regulations, client specific policies and VARIS policies and procedures and shares applicable changes with appropriate individuals in the organization

Maintains and ensures the protection of patient information with the application of the HIPAA standards and individual client contracts and policies

Performs or assists with system testing and special projects as needed

Performs selections and identifies methods to optimize the results of the selection process

Performs case validations

Performs other duties as assigned

Qualification

RHIA certificationRHIT certificationCCS certificationDRG validation experienceICD-10 trainingHospital inpatient codingOperations analysisMultiple task orientationOralMS OfficeDRG Grouper softwareEncoder softwareEffective communicationLeadership skillsOrganization skillsFlexibilityWritten skillsPresentation skills

Required

National certification as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), and/or Certified Coding Specialist (CCS). Highly recommend ICD-10 specialized training

Comprehensive knowledge of the DRG structure and other health care payment methodologies and regulatory requirements

Minimum of five to seven years hospital inpatient coding for PPS reimbursement or at least 2 years experience performing DRG validation

Proven self-direction in the planning and execution of DRG validation and recovery functions

Demonstrated exemplary professional coding judgment

Confirmed effective communication in staff supervision and teaching

Proven operations analysis, including productivity and financial skills

Ability to adhere to the highest ethical standards including honesty, integrity, dedication and leadership

Demonstrated ability to gain support for ideas and lead others to accomplish objectives

Demonstrated success rate in selection of cases that result in overpayment/recovery

Organization, flexibility and multiple task/project orientation to handle duties assigned

Skill in focusing on desired results, determining what is important and urgent, clarifying next steps, and delegating effectively to meet deadlines and achieve desired results

Must possess excellent oral, written and presentation skills

Demonstrated proficiency in multiple computer applications (MS Office), DRG Grouper/Pricer software, and encoder software